Constipation in children

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Última revisão: 11 Dec 2025

Última atualização: 07 Jan 2025

Childhood constipation is typically characterized by infrequent bowel evacuations, large stools, and difficult or painful defecation.

Symptoms often result from low fiber, poor nutrient, poor stooling technique, and/or insufficient water intake, which leads to excessive hardening of the stool. This often starts as an acute problem but can progress to fecal impaction and chronic constipation.

Particularly in young children, any cause of painful defecation may provoke active withholding. Withholding may worsen the constipation and lead to a vicious cycle.

Duration of constipation and amount of stool burden may depend on capacity of the child's rectum, the degree of rectal dilation (if excessive, often called megarectum), and other factors including rectal sensory function.

After fecal disimpaction, maintenance stool softeners are essential and are often required for many months or years to reduce relapse risk.

Definição

Constipation in childhood is the infrequent passage of stools leading to 1 or more of the following: painful defecation; overflow fecal incontinence; rectal fecal impaction; or active defecation avoidance behavior.

História e exame físico

Principais fatores diagnósticos

difficult or painful defecation
long interval between stools
fecal incontinence
small-volume, soft, incontinent stool
palpable fecal mass per abdomen
otherwise healthy child

Detalhes completos

Outros fatores diagnósticos

abdominal pain
abdominal distention
anal fissure
associated bladder problems
abnormal anal appearance

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

no initial test

Detalhes completos

Investigações a serem consideradas

abdominal radiograph
radiopaque marker colonic transit study
abdominal ultrasound
contrast enema
rectal suction biopsy
psychological assessment

Detalhes completos

Novos exames

anorectal manometry
colonic manometry

Algoritmo de tratamento

AGUDA

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

Colaboradores

Autores

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

Declarações

JB-G declares that he has no competing interests.

Claire Zar-Kessler, MD

Instructor in Pediatric Gastroenterology

Massachusetts General Hospital for Children

Boston

Declarações

CZ-K has received support from Takeda for a clinical trial on prucalopride.

Agradecimentos

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.

Declarações

CB, WE-M, SR, and MM declare that they have no competing interests.

Revisores

David C.A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU

Consultant Paediatric Gastroenterologist

Royal West Sussex NHS Trust

Chichester

Declarações

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

Vikram Boolchand, MD

Gastroenterology Fellow

University of Arizona

Tucson

Declarações

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

Declarações

DJH declares that he has no competing interests.

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Referências

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Principais artigos

Rubin G, Dale A. Chronic constipation in children. BMJ. 2006 Nov 18;333(7577):1051-5.Texto completo Resumo

Mulhem E, Khondoker F, Kandiah S. Constipation in children and adolescents: evaluation and treatment. Am Fam Physician. 2022 May 1;105(5):469-78. Resumo

National Institute for Health and Care Excellence. Constipation in children and young people: diagnosis and management. Jul 2017 [internet publication].Texto completo Resumo

Benninga MA, Faure C, Hyman PE, et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016 Feb 15 [Epub ahead of print]. Resumo

Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016 Feb 15 [Epub ahead of print]. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Differentials
- Hirschsprung disease
- Anorectal anomaly
- Group A streptococcal perianal skin infection
Mais Differentials
Guidelines
- Constipation in children and adolescents: evaluation and treatment
- Childhood constipation
Mais Guidelines
Patient information
Anal tears
Constipation in children
More Patient information
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Constipation in children

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

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

Colaboradores

Autores

Jaime Belkind-Gerson, MD, MSc

Declarações

Claire Zar-Kessler, MD

Declarações

Agradecimentos

Declarações

Revisores

David C.A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU

Declarações

Vikram Boolchand, MD

Declarações

David J. Hackam, MD, PhD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice