Abdominal pain-predominant FGD affects 12.5% of children ages 10 to 16 years and constitutes a significant health problem in Sri Lanka. IBS is the most common FGD subtype present. Abdominal pain-predominant FGD are higher in girls and those exposed to emotional stress. Prevalence of FGD decreased with age. Extraintestinal symptoms are more frequent in affected children.

Little is known about the prevalence of functional gastrointestinal diseases (FGDs) in adolescents, especially in developing countries. This cross-sectional survey conducted in a semi-urban school in Sri Lanka, assessed the prevalence of whole spectrum of FGDs in 427 adolescents (age 12-16 years) using a validated self-administered questionnaire. According to Rome III criteria, 123 (28.8%) adolescents had FGDs. Of them, 59 (13.8%) had abdominal-pain-related FGDs [irritable bowel syndrome (IBS) 30, functional dyspepsia 15, functional abdominal pain 13 and abdominal migraine 1]. Prevalence of functional constipation, aerophagia, adolescent rumination syndrome, cyclical vomiting syndrome and non-retentive faecal incontinence were 4.2, 6.3, 4, 0.5 and 0.2%, respectively. Only 58 (13.6%) adolescents were found to have FGDs when Rome II criteria were used. In conclusion, FGDs were present in more than one-fourth of adolescents in the study group, of which IBS was the most common. Rome III criteria were able to diagnose FGDs more comprehensively than Rome II.

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 modalities.

Emotional stress is associated with some functional gastrointestinal diseases, but its role in aetiology of functional constipation is unclear. This island-wide, questionnaire-based, cross-sectional survey was conducted to assess the association between constipation and emotional stress, in 10-16-year-olds. Constipation was defined using Rome III criteria. Out of 2699 children included in the analysis, 416 (15.4%) had constipation. Constipation was higher in those exposed to stressful events (odds ratio 2.52, p < 0.0001). Separation from the best friend, failure in an examination, severe illness of a family member, loss of job by a parent, frequent punishment by parents and living in an area affected by separatist war remained independently associated with constipation (p < 0.05). In conclusion, constipation was significantly higher in children exposed to stressful life events. Modulation of gut motility through brain-gut axis probably alters colonic transit and ano-rectal functions, causing constipation.

Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. Alteration of rectal and pelvic floor function through the brain-gut axis seems to play a crucial role in the etiology. The diagnosis is often a symptom-based clinical process. Recently developed Rome III diagnostic criteria looks promising, both in clinical and research fields. Laboratory investigations such as barium enema, colonoscopy, anorectal manometry and colonic transit studies are rarely indicated except in those who do not respond to standard management. Treatment of childhood constipation involves several facets including education and demystification, toilet training, rational use of laxatives for disimpaction and maintenance and regular follow-up. Surgical options should be considered only when medical therapy fails in long standing constipation. Since most of the management strategies of childhood constipation are not evidence-based, high-quality randomized controlled trials are required to assess the efficacy of currently available or newly emerging therapeutic options. Contrary to the common belief that children outgrow constipation as they grow up, a sizable percentage continue to have symptoms beyond puberty.

Summary Background Faecal incontinence (FI) in children is a significant gastrointestinal problem, with great personal and social impacts. It is characterised by recurrent loss of faecal matter into the underwear. Both functional and organic causes contribute to its aetiology with the former predominating. Aim To review the epidemiology, pathophysiology, clinical evaluation and management of functional faecal incontinence in children. Methods A PubMed search was conducted using search terms f(a)ecal incontinence, and encopresis. Articles on epidemiology, pathophysiology, clinical evaluation, investigation and management of functional FI in children were retrieved and assessed. Results Community prevalence of this distressing problem ranges from 0.8% to 7.8% globally. Male: female ratio varies from 3:1 to 6:1. The diagnosis of FI is often based on established clinical criteria. The majority (82%) have constipation associated functional FI. Biopsychosocial factors play a crucial role in the pathogenesis. Limited physiological testing of anorectal function is recommended in the diagnostic procedures, particularly in children with atypical symptoms and possible organic disorders. Management of FI needs a multidisciplinary approach which includes establishment of an effective doctor‐patient partnership, understanding the underlying mechanisms, pharmacotherapy and behavioural treatment. Approximately 15% of children with functional nonretentive faecal incontinence (FNRFI) had the same symptoms at the age of 18 years. Conclusion Significant therapeutic advances have been made for retentive faecal incontinence, but treatment options for functional nonretentive faecal incontinence are limited. Limited long‐term outcome data show that the majority outgrow faecal incontinence. A substantial proportion of children progress to adulthood with faecal incontinence.

Constipation is a common paediatric problem, but its prevalence in Asia is unknown. A cross-sectional survey using a previously validated, self-administered questionnaire was conducted in randomly selected children aged 10-16 years, in five randomly selected schools in Sri Lanka. Two schools were in Eastern Province, which has been affected by the separatist war. Constipation was defined using Rome III criteria. Of 2694 children included in the analysis, 416 (15.4%) had constipation. Symptoms independently associated with constipation were straining (71.6% vs 28.4% of controls), bleeding per rectum (14.2% vs 2.2%) and abdominal pain (55% vs 35.2%). The prevalence of constipation was significantly higher in those with a family history of constipation (49% vs 14.8%), living in a war affected area (18.1% vs 13.7%) and attending an urban school (16.7% vs 13.3%). In conclusion, chronic constipation is a significant problem affecting 15% of Sri Lankan school children and adolescents.

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