Association between childhood constipation and exposure to stressful life events: a systematic review

Abstract

Background Several cross‐sectional studies have reported an association between childhood constipation and exposure to stressful events. We planned to systematically review the literature on constipation and its associated stressful events. Methods PubMed, Embase, and PsycINFO databases were searched (until February 2021) using standard search terms related to “constipation” and “stress” from 0 to 18 years that describe the association between psychological stressors and constipation. Studies were screened using pre‐designed eligibility criteria. Studies that fulfilled the criteria were reviewed in a full‐text format. The quality assessment of selected articles was conducted using standard methods. Key Results Of 2296 titles and abstracts screened, 38 were included in the full‐text review. Out of that, 15 articles were included in this systematic review. There were 2954 children with constipation, and the age range was from 6 months to 16 years. Exposure to home‐related stressors (divorce or separation of parents, severe illness in family, and parental job loss) school‐related stressors (including being bullied at school, change in school, separation from the best friend at school, and failure in an examination), exposure to child maltreatments and exposure to war/civil unrest were associated with childhood constipation. Conclusions and Inferences Exposure to day‐to‐day home‐ and school‐related stressors, to child maltreatment, and to civil unrest is associated with constipation in children and adolescents. These factors need to be explored during clinical evaluation of children with constipation.

Pediatric Functional Constipation in Clinical Practice: The Continuous Search for the Light at the End of the Tunnel

“…It defined child maltreatment, divorce/separation of parents, severe illness in the family, and parental job loss as home stressors. In the same way, bullying, change in school, separation from the best friend, and failure on examination as school-related stressors were associated with childhood constipation [44].…”

Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis

“…In agreement with our findings relating to barriers and facilitators to implementation, the importance of the context in which the child is living was highlighted by a recent SR which identified 15 primary studies which explored the 'association between childhood constipation and exposure to stressful events'. 392 The authors conclude that stressful events experienced by children (e.g. parental separation, family illness, being bullied) are associated with CFC.…”

“…This is supported by a recent SR, which concludes that lack of knowledge and understanding is a key issue faced by families/carers of children with CFC, and research to identify effective educational/ informational strategies a priority. 392 Our focus was on management of CFC in children, and -while we considered psychosocial and behavioural interventions -we did not consider the psychosocial and behavioural factors which may contribute to poor outcomes. For example, there is evidence that some children may actively avoid using school toilets 395 and concern has been raised about the impact of this on children with bowel problems.…”

Relationship between psychological stress with functional constipation in children: a systematic review

“…A link was identified between psychological anxiety and pelvic floor tension. Blood flow from the rectal mucosa to the intestine and the extrinsic nerve increases [ 2 , 23 ]. Functional magnetic resonance imaging (MRI) studies have demonstrated a linked between functional gastrointestinal disorders with activation of the anterior midcingulate and posterior cingulate, as well as deactivation of the anterior cingulate cortical supragenual region, which linked to downregulation of pain signals in children who have been exposed to abuse [ 24 ].…”