Constipation in the paediatric practice

Constipation is a common reason for patients to visit both the general paediatrician and paediatric gastroenterologist. Up to 95%of constipation cases are functional in nature, with only 5% accounting for the so-called symptomatic constipation, occurring invarious intestinal and extraintestinal conditions. The diagnosis of functional constipation can be established based on a typicalhistory and clinical manifestations. One must evaluate the warning signs and, subsequently, the success of adequate treatment.When symptomatic constipation is suspected, a multidisciplinary approach is warranted. The treatment of functional constipationmust be comprehensive, is often long term, and places considerable demands on the patient, family, and physician. At treatmentinitiation, it is essential to release the impacted stool using a nonfermentable laxative while trying to minimize manipulation withthe rectum. This is followed by an individually tailored maintenance therapy of sufficient duration accompanied by defecationtraining and regular check-ups. Polyethylene glycol (macrogol 4000) is the laxative of first choice for both phases of the treatment.Dietary modifications and psychological support of the family and child in an often embarrassing situation associated with encopresisalso play an important role in treatment. The last step, once all the constipation symptoms have been managed, is thegradual discontinuation of laxatives. The significance of proper management of children with constipation is also underpinnedby the fact that, in up to 20% of children who have chronic constipation, constipation persists to a varying degree in adulthood.Currently, evidence is lacking concerning the majority of guidelines that would follow from randomized controlled trials. Mostguidelines are thus based on an expert consensus or synthesis of knowledge in review studies. The therapeutic guidelines presentedare particularly applicable to patients with functional constipation.

Keywords: constipation, children, diagnosis, treatment, polyethylene glycol