The final document is not a systematic literature review. It includes relevant research when available, as well as expert opinion on the current understanding of functional constipation in children with lower urinary tract symptoms. The document is intended to be clinically useful in primary, secondary and tertiary care settings.

Most of the children between 5 and 8 years of age have a medium-size bowel movement daily or every other day without straining or withholding. Although African American children toilet train at an earlier age than do white children, bowel habits appear to be similar. A sizeable subgroup of children presenting to primary care providers have a history that is consistent with constipation.

No abstract

Transabdominal ultrasound is a noninvasive and reliable alternative to assess the rectal filling state, and might replace digital rectal examination in the evaluation of children with constipation.

Significant differences in practice exist among PCP from different countries regarding the performance of a digital rectal examination, need for additional diagnostic tests and use of laxatives in childhood constipation.

In almost 70% of children with lower urinary tract symptoms rectal distention significantly but unpredictably affected bladder capacity, sensation and overactivity regardless of whether the children had constipation, and independent of clinical features and baseline urodynamic findings. Urodynamics and management protocols for lower urinary tract symptoms that fail to recognize the effects of rectal distention may lead to unpredictable outcomes.

More than 50% of children with lower urinary tract symptoms evaluated at a tertiary referral center fulfilled the diagnostic criteria for functional defecation disorders. We recommend evaluating bowel habits as part of the initial assessment of a child who presents with urological symptoms. Future studies of the effect on urological symptoms of treating functional defecation disorders are justified.

SS catheters are more sensitive in recording HAPCs in children with defecation disorders compared with the more traditional WP assembly. There is a difference in measurements of amplitude between the two systems. Solid-state catheters offer potential advantages over WP catheters in children, being portable, safer to use, and may provide data over a more prolonged period.