Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • hx of anorectal, neurologic, or spinal abnormalities, or GI surgery
  • fecal soiling or diarrhea
  • constipation
  • perianal skin irritation
  • abnormal rectal examination
  • spinal deformites
  • weakness and decreased or absent reflexes

Other diagnostic factors

  • behavior problems
  • painful bowel movements
  • abdominal pain/cramping
  • posturing described as tightening of buttocks
  • enuresis
  • anorectal malformation
  • abnormal abdominal examination
  • hx of underlying medical condition

Risk factors

  • chronic constipation
  • male sex
  • age: 5 to 6 years
  • diet lacking in fiber
  • inadequate fluid intake
  • delayed or inadequate toilet training
  • anorectal malformations
  • Hirschsprung disease
  • spinal abnormalities
  • psychological or behavioral problems due to stressful family events
  • psychiatric disorders
  • medication overuse

Diagnostic investigations

Investigations to consider

  • unprepared barium enema
  • spinal x-ray
  • MRI spine
  • radiopaque marker transit radiograph
  • colonic and rectal manometry studies
  • rectal biopsy
  • serum TSH level
  • serum free T4 level
  • sweat chloride test
  • tissue transglutaminase IgA
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Linda S. Nield

Professor of Pediatrics

West Virginia University School of Medicine

Morgantown

WV

Disclosures

LSN is an author of a reference cited in this monograph.

Associate Professor of Pediatrics

Section Chief of Pediatric Gastroenterology, Hepatology and Nutrition

West Virginia University School of Medicine

Morgantown

WV

Disclosures

BDR declares that he has no competing interests.

Dr Linda S. Nield and Dr Brian D. Riedel would like to gratefully acknowledge Dr Uwe Blecker, a previous contributor to this monograph.

Disclosures

UB declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Division of Pediatric Urology

Monroe Carell Jr. Children's Hospital at Vanderbilt

Nashville

TN

Disclosures

JCT declares that he has no competing interests.

Consultant Paediatrics Gastroenterologist

Western Sussex Hospitals NHS Trust

Chichester

Honorary Consultant Paediatric Gastroenterologist

Royal Alexandra Children's Hospital

Brighton and Sussex University Hospitals

Brighton

UK

Disclosures

DCAC has received research grants, consultancy fees, and reimbursement of conference expenses from Norgine UK, the manufacturer of Movicol. He is the author of a systematic review of polyethylene glycol-based laxatives; convenor of the Paris Consensus on Constipation Terminology Group; and external advisor of the NICE paediatric constipation guideline development group.

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