Constipation in children

Last reviewed: 1 Sep 2023
Last updated: 09 Feb 2023

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
More key diagnostic factors

Other diagnostic factors

  • abdominal pain
  • abdominal distention
  • anal fissure
  • associated bladder problems
  • abnormal anal appearance
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • no initial test
More 1st investigations to order

Investigations to consider

  • abdominal radiograph
  • radiopaque marker colonic transit study
  • abdominal ultrasound
  • contrast enema
  • rectal suction biopsy
  • psychological assessment
More investigations to consider

Emerging tests

  • anorectal manometry
  • colonic manometry

Treatment algorithm

ACUTE

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.

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  • Guidelines

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