Summary
Definition
History and exam
Key diagnostic factors
- difficult or painful defecation
- long interval between stools
- fecal incontinence
- small-volume, soft, incontinent stool
- palpable fecal mass per abdomen
- otherwise healthy child
Other diagnostic factors
- abdominal pain
- abdominal distention
- anal fissure
- associated bladder problems
- abnormal anal appearance
Risk factors
- low-fiber diet
- poor-nutrient diet
- genetic predisposition
- infection
- stress
- obesity
- low birth weight
- psychiatric history
- physical disability
- poor toilet training
- immune dysregulation
- low fluid intake
- trauma
Diagnostic tests
1st tests to order
- no initial test
Tests to consider
- abdominal radiograph
- radiopaque marker colonic transit study
- abdominal ultrasound
- contrast enema
- rectal suction biopsy
- psychological assessment
Emerging tests
- anorectal manometry
- colonic manometry
Treatment algorithm
no impaction: <1 year of age
no impaction: ≥1 year of age
with impaction: <1 year of age
with impaction: 1-3 years of age
with impaction: ≥4 years of age
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 received support from Takeda for a clinical trial on prucalopride.
Acknowledgements
Dr Jaime Belkind-Gerson and Dr Claire Zar-Kessler would like to gratefully acknowledge Dr Corey Baker, Dr Wael El-Matary, Dr Steffen Reinsch, and Dr Meghan McPherson, the previous contributors to this topic.
Disclosures
CB, WE-M, SR, and MM declare that they have no competing interests.
Peer reviewers
David C.A. Candy, MBBS, 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.
References
Key articles
Rubin G, Dale A. Chronic constipation in children. BMJ. 2006 Nov 18;333(7577):1051-5.Full text Abstract
Mulhem E, Khondoker F, Kandiah S. Constipation in children and adolescents: evaluation and treatment. Am Fam Physician. 2022 May 1;105(5):469-78. Abstract
National Institute for Health and Care Excellence. Constipation in children and young people: diagnosis and management. Jul 2017 [internet publication].Full text Abstract
Benninga MA, Faure C, Hyman PE, et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016 Feb 15 [Epub ahead of print]. Abstract
Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016 Feb 15 [Epub ahead of print]. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hirschsprung disease
- Anorectal anomaly
- Group A streptococcal perianal skin infection
More DifferentialsGuidelines
- Constipation in children and adolescents: evaluation and treatment
- Childhood constipation
More GuidelinesPatient information
Anal tears
Constipation in children
More Patient information
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