Summary
Definition
History and exam
Key diagnostic factors
- history of anorectal, neurologic, or spinal abnormalities, or gastrointestinal surgery
- fecal soiling or diarrhea
- constipation
- perianal skin irritation
- abnormal rectal examination
- spinal deformities
- 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
- history 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
1st investigations to order
- abdominal x-ray
Investigations to consider
- unprepared barium enema
- spinal x-ray
- MRI spine
- radiopaque marker transit radiograph
- colonic and rectal manometry studies
- rectal biopsy
- serum thyroid-stimulating hormone level
- serum free thyroxine (T4) level
- sweat chloride test
- tissue transglutaminase IgA
Treatment algorithm
with constipation and fecal impaction
without constipation
fecal impaction resolved
Contributors
Authors
Brian D. Riedel, MD
Clinical Associate Professor of Pediatrics Emeritus
Pediatric Gastroenterology, Hepatology and Nutrition
West Virginia University School of Medicine
Morgantown
WV
Disclosures
BDR declares that he has no competing interests.
Acknowledgements
Dr Brian D. Riedel would like to gratefully acknowledge Dr Linda S. Nield and Dr Uwe Blecker, previous contributors to this topic.
Disclosures
UB declares that he has no competing interests. LSN is an author of a reference cited in this topic.
Peer reviewers
John C. Thomas, MD
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.
David C. A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU
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 National Institute for Health and Care Excellence pediatric constipation guideline development group.
Differentials
- Nonspecific toddler's diarrhea
- Irritable bowel syndrome (IBS) with alternating constipation and diarrhea
- Infectious diarrhea
More DifferentialsGuidelines
- Constipation
- Sixth International Consultation on Incontinence recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence
More GuidelinesPatient leaflets
Constipation in children
More Patient leaflets
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