Resumo
Definition
History and exam
Key diagnostic factors
- história de anormalidades anorretais, neurológicas ou espinhais ou cirurgia gastrointestinal
- encoprese ou diarreia
- constipação
- irritação da pele perianal
- exame retal anormal
- deformidade espinhal
- fraqueza e reflexos reduzidos ou ausentes
Other diagnostic factors
- problemas comportamentais
- evacuações dolorosas
- dor abdominal/cólica
- postura descrita como contração das nádegas
- enurese
- malformação anorretal
- exame abdominal anormal
- história da afecção clínica subjacente
Risk factors
- constipação crônica
- sexo masculino
- idade: 5 a 6 anos de idade
- ausência de fibras alimentares
- ingestão inadequada de líquidos
- treinamento esfincteriano tardio ou inadequado
- malformações anorretais
- Doença de Hirschsprung
- anormalidades espinhais
- problemas psicológicos ou comportamentais devido a eventos familiares estressantes
- transtornos psiquiátricos
- uso excessivo de medicamentos
Diagnostic investigations
1st investigations to order
- radiografia abdominal
Investigations to consider
- enema de bário não preparado
- radiografia da coluna total
- RNM da coluna vertebral
- radiografia de trânsito do marcador radiopaco
- estudos de manometria anorretal e colônica
- biópsia retal
- hormônio estimulante da tireoide (TSH) sérico
- nível de tiroxina livre sérica (T4)
- teste de cloreto no suor
- imunoglobulina A (IgA) transglutaminase tecidual
Treatment algorithm
com constipação e impactação fecal
sem constipação
impactação fecal remitida
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 paediatric constipation guideline development group.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016 May;150(6):1456-68. Abstract
Levitt MA, Pena A. Anorectal malformations. Orphanet J Rare Dis. 2007 Jul 26;2:33.Full text Abstract
Bongers ME, Tabbers MM, Benninga MA. Functional nonretentive fecal incontinence in children. J Pediatr Gastroenterol Nutr. 2007 Jan;44(1):5-13.Full text Abstract
Abrams P, Andersson KE, Apostolidis A, et al. 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn. 2018 Sep;37(7):2271-2.Full text 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
- Diarreia inespecífica infantil
- Síndrome do intestino irritável com constipação e diarreia alternadas
- Diarreia infecciosa
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 information
Constipação em crianças
More Patient information
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