Current Practice Constipation in children: diagnosis and management

Constipation is a common gastrointestinal disorder in children and adolescents accounting for a significant healthcare burden. Clinical spectrum ranges from mild constipation that resolves spontaneously to chronic treatment resistant constipation with devastating physical and psychosocial consequences. This article provides clinicians with a current concise review of diagnostic and management strategies of constipation. Definitions Constipation had been a difficult condition to diagnose due to a lack of uniform diagnostic criteria. It was often perceived as a symptom rather than a disorder. Therefore many researchers an

Childhood constipation: Current status, challenges, and future perspectives

Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and demystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures

Children and adolescents with chronic constipation: how many seek healthcare and what determines it?

This island-wide cross-sectional survey was conducted to assess the healthcare consultations in Sri Lankan children with constipation. Children aged 10-16 years were randomly selected from five randomly selected schools in three randomly selected provinces of Sri Lanka. Data were collected using a pre-tested questionnaire based on Rome III criteria. Of the 2770 questionnaires distributed, 2694 (97.3%) properly filled questionnaires were included in the analysis. From 416 (15.4%) children with chronic constipation, only 16 (3.8%) had sought medical advice during the previous 12 months. Younger children and those with a similar family history were more likely to seek healthcare. The majority of children with symptoms indicating severe constipation such as painful defecation, large volume stool, faecal incontinence and blood stained stools had not sought medical help for their symptoms. Parents should pay more attention to bowel habits of their children to identify and treat constipation early to prevent complication

Constipation-associated and Nonretentive Fecal Incontinence in Children and Adolescents: An Epidemiological Survey in Sri Lanka

Objectives: Fecal incontinence (FI) has a great effect on quality of life of children with the condition. Epidemiological data related to FI from developing countries are sparse. Studies differentiating functional nonretentive and retentive (constipation-associated) FI are not available. Patients and Methods: This was an island-wide, cross-sectional study. Information was collected from children (ages 10-16 years) from 5 randomly selected schools in 3 geographically and socioeconomically different provinces in Sri Lanka, using a validated, self-administered questionnaire. FI was defined as defecation into places inappropriate to the social context, at least once per month, for a minimum period of 2 months. Constipation was diagnosed using Rome III criteria. Results: A total of 2770 questionnaires were distributed and 2686 (97.0%) were included in the analysis. Of them, 55 (2.0%) had FI (mean age 11.96 years, SD 1.59 years, 43 [78.2%] boys). Forty-five (81.8%) had constipation-associated FI and 10 (18.2%) had nonretentive FI. The highest prevalence of FI was seen in children aged 10 years (5.4%). A significant negative correlation was observed between age and the prevalence of FI (r = -0.893, P = 0.007). FI was significantly higher in boys (boys 3.2%, girls 0.9%), those exposed to recent school-and family-related stressful life events, and those from lower social classes (P <0.05). Conclusions: FI is not uncommon among children and adolescents of 10 to 16 years of age in Sri Lanka with a male predilection. Some predisposing factors, such as exposure to stressful life events and being bullied at school, which are similar to those described in the literature for FI, could be clearly recognize

Quality of life and health care consultation in 13 to 18 year olds with abdominal pain predominant functional gastrointestinal diseases

Abdominal pain predominant functional gastrointestinal diseases (AP-FGD) are commonly seen in the paediatric age group. It has significant impact on daily activities of affected children. Main objective of this study was to assess the health related quality of life (HRQoL) in children with AP-FGD. This was a cross sectional survey conducted in children aged 13-18 years, in four randomly selected schools in Western province of Sri Lanka. Data was collected using a previously validated, self-administered questionnaire. It had questions on symptoms, HRQoL and health care consultation. AP-FGD were diagnosed using Rome III criteria. A total of 1850 questionnaires were included in the analysis [males 1000 (54.1%), mean age 14.4 years and SD 1.3 years]. Of them, 305 (16.5%) had AP-FGD [irritable bowel syndrome = 91(4.9%), functional dyspepsia = 11 (0.6%), abdominal migraine = 37 (1.9%) and functional abdominal pain = 180 (9.7%)]. Lower HRQoL scores for physical (83.6 vs. 91.4 in controls), social (85.0 vs. 92.7), emotional (73.6 vs. 82.7) and school (75.0 vs. 82.5) functioning domains, and lower overall scores (79.6 vs. 88.0) were seen in children with AP-FGD (p < 0.001). A weak but significant negative correlation was observed between HRQoL score and severity of abdominal pain (r = -0.24, p < 0.0001). Eighty five children (27.9%) had sought healthcare for AP-FGD. Factors determining healthcare seeking were presence of abdominal bloating and vomiting (p < 0.05). Children with AP-FGD have lower quality of life in all 4 domains. Those with severe symptoms have lower HRQoL. Approximately 28% of children with AP-FGD seek healthcare for their symptom

Abdominal migraine in children: association between gastric motility parameters and clinical characteristics

Approximately 0.2-1 % of children suffers from abdominal migraine (AM). Pathophysiology of AM has not been adequately studied. This study evaluated gastric motility in children with AM. Seventeen children (6 boys), within an age range of 4-15 years, referred to a tertiary care paediatric unit, North Colombo Teaching Hospital Ragama, Sri Lanka, from 2007 to 2012, were screened. Those fulfilling Rome III criteria for AM were recruited after obtaining parental consent. None had clinical or laboratory evidence of organic disorders. Twenty healthy children (8 boys), with an age range of 4-14 years, were recruited as controls. Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound method. Average GE (41.6 % vs. 66.2 %, in controls), amplitude of antral contractions (A) (57.9 % vs. 89.0 %) and antral motility index (MI) (5.0 vs. 8.3) were lower and fasting antral area (1.8 cm(2) vs. 0.6 cm(2)) was higher in children with AM (p < 0.01). No significant difference in the frequency of antral contractions (F) (8.8/3 min vs. 9.3/3 min, p = 0.08) was found between the two groups. Scores obtained for severity of abdominal pain had a negative correlation with A (r = -0.55, p = 0.03). Average duration of abdominal pain episodes correlated with GE (r = -0.58, p = 0.02). Negative correlations were observed between duration of AM and A (r = -0.55), F (r = -0.52), and MI (r = -0.57) (p < 0.05). GE and antral motility parameters were significantly lower in children with AM. A significant correlation was found between symptoms and gastric motility. These findings suggest a possible role of abnormal gastric motility in the pathogenesis of A

Functional Fecal Incontinence in Children: Epidemiology, Pathophysiology, Evaluation, and Management

ABSTRACT: Functional fecal incontinence (FI) is a worldwide problem in children and comprises constipation-associated FI and nonretentive FI. Irrespective of pathophysiology, both disorders impact negatively on the psychological well-being and quality of life of affected children. A thorough clinical history and physical examination using the Rome IV criteria are usually sufficient to diagnose these conditions in most children. Evolving investigations such as high-resolution anorectal and colonic manometry have shed new light on the pathophysiology of functional FI. Although conventional interventions such as toilet training and laxatives successfully treat most children with constipation-associated FI, children with nonretentive FI need more psychologically based therapeutic options. Intrasphincteric injection of botulinum toxin, transanal irrigation and, in select cases, surgical interventions have been used in more resistant children with constipation-associated FI

Childhood constipation as an emerging public health problem

Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalitie