Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- defecação difícil ou dolorosa
- intervalos longos entre as defecações
- incontinência fecal
- incontinência fecal de pequeno volume e mole
- massa fecal palpável no abdome
- crianças saudáveis de um modo geral
Other diagnostic factors
- dor abdominal
- distensão abdominal
- fissura anal
- problemas vesicais associados
- aparência anal anormal
Risk factors
- dieta com baixo teor de fibras
- dieta deficiente em nutrientes
- predisposição genética
- infecção
- estresse
- obesidade
- baixo peso ao nascer
- história psiquiátrica
- deficiência física
- treinamento esfincteriano inadequado
- desregulação imune
- baixa ingestão de líquidos
- trauma
Diagnostic investigations
1st investigations to order
- nenhum exame inicial
Investigations to consider
- radiografia abdominal
- estudo do trânsito colônico do marcador radiopaco
- ultrassonografia abdominal
- enema com contraste
- biópsia retal por sucção
- avaliação psicológica
Emerging tests
- manometria anorretal
- manometria colônica
Treatment algorithm
sem impactação: <1 ano de idade
sem impactação: ≥1 ano de idade
com impactação: <1 ano de idade
com impactação: 1 a 3 anos de idade
com impactação: ≥4 anos de idade
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.
Differentials
- Doença de Hirschsprung
- Anomalia anorretal
- Infecção cutânea perianal por estreptococos do grupo A
More DifferentialsGuidelines
- Constipation in children and adolescents: evaluation and treatment
- Childhood constipation
More GuidelinesPatient information
Anal tears
Constipation in children
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