Last reviewed: 1 Nov 2021
Last updated: 08 Feb 2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • difficult or painful defecation
  • long interval between stools
  • faecal incontinence
  • small-volume, soft, incontinent stool
  • palpable faecal mass per abdomen
  • otherwise healthy child

Other diagnostic factors

  • abdominal pain
  • anal fissure
  • associated bladder problems
  • abnormal anal appearance
  • abnormal neurological examination

Risk factors

  • low-fibre diet
  • poor-nutrient diet
  • genetic predisposition
  • infection
  • stress
  • obesity
  • low birth weight
  • psychiatric history
  • immune dysregulation
  • low fluid intake
  • trauma

Diagnostic investigations

Investigations to consider

  • abdominal x-ray
  • radiopaque marker colonic transit study
  • abdominal ultrasound
  • pelvic ultrasound
  • rectal mucosal biopsy
  • psychological assessment

Emerging tests

  • endoanal sonography
  • anorectal manometry
  • colonic manometry

Treatment algorithm

Contributors

Authors

Jaime Belkind-Gerson, MD, MSc

Director Neurogastroenterology and Motility Program

Digestive Health Institute

Children's Hospital Colorado

Associate Professor of Pediatrics

University of Colorado School of Medicine

Colorado

CO

Disclosures

JB-G declares that he has no competing interests.

Claire Zar-Kessler, MD

Instructor in Pediatric Gastroenterology

Massachusetts General Hospital for Children

Boston

MA

Disclosures

CZ-K has been reimbursed by Genzyme for speaking at several conferences.

Corey Baker, MD

Fellow in Pediatric Gastroenterology

Massachusetts General Hospital for Children

Boston

MA

Disclosures

CB declares that he has no competing interests.

Acknowledgements

Dr Jaime Belkind-Gerson, Dr Claire Zar-Kessler, and Dr Corey Baker would like to gratefully acknowledge Dr Wael El-Matary, Dr Steffen Reinsch, and Dr Meghan McPherson, the previous contributors to this topic. WE-M, SR, and MM declare that they have no competing interests.

Peer reviewers

David C.A. Candy, MB.BS, MSc, MD, FRCP, FRCPCH, FCU

Consultant Paediatric Gastroenterologist

Royal West Sussex NHS Trust

Chichester

UK

Disclosures

DCAC has served as a consultant to, and spoken at symposia sponsored by, Norgine Ltd.

Vikram Boolchand, MD

Gastroenterology Fellow

University of Arizona

Tucson

AZ

Disclosures

VB declares that he has no competing interests.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

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