Clinical and alimentary history of children attending a pediatric gastroenterology outpatient clinic with functional chronic constipation and its possible complications

Abstract

In order to better understand the natural history of chronic functional constipation, a questionary was applied to 163 children and infants, before beginning standardized treatment. Median age (range) at start was 3mo(0-108mo) but age at arrival at the Pediatric Gastroenterology Unit was 53mo(2-146mo). In 62,4% of the cases symptoms began before or up to 3mo after cow's milk introduction and rarely around (±6mo) toilet training. Possible complications appeared progressively, often at preschool or school age or as the first noticeable manifestation: recurrent abdominal pain (61,1%), fecal soiling (45,4%), fecal blood (35%), enuresis (23,3%), vomiting (19%), urinary infection (17,9%), urinary retention (8,6%). Abdominal distension was rarely detected on physical examination and was usually discrete. In conclusion, children attended in Botucatu begin their constipation at an early age, frequently associated with weaning, and important complications may ensue along years. This evolution should be avoided by prevention and early treatment of constipation.

Some Risk Factors of Chronic Functional Constipation Identified in a Pediatric Population Sample from Romania

“…On the other hand, Loening-Baucke assesses the prevalence rates for constipation during the first and second year of life at 2.9 and 10.1%, respectively [11]. Our results indicate that the majority of constipated children included in this study had the onset of constipation within the first two years of life; these results are consistent with other previous studies [12–14]. The number of doctor visits for children aged 0 to 9 years on account of constipation problems has doubled in recent years, and the highest increase was reported among children under the age of 2 years [15, 16].…”

Recalled and recorded bowel habits confirm early onset and high frequency of constipation in day-care nursery children

“…These studies should contemplate complete physical examination, diagnostic studies and therapeutic interventions with follow up, to investigate whether children classified as constipation by recall, but as "other BH", by record, may have overflow incontinence due to fecal retention. In fact, it is our clinical experience that some young children present soiling associated with constipation even before age 4 years, which disappears soon after beginning stool disimpaction (18,19) . The adult criterion, if confirmed as desirable and being stricter, would perhaps allow earlier constipation detection and earlier therapeutic intervention before undesirable complications ensue.…”

“…Questions were directed to recall the usual BH over the previous 30 days and included the items: presence of straining/painful defecations usually, weekly stool frequency and most frequent/predominant stool characteristics (consistency/form). Stool characteristics asked about were: soft (mushy or like a smooth banana, with, at most, superficial cracks), hard (scybalous, pebble-like or cylindrical with deep cracks), runny (unformed stools that flow, or watery), soft being the adequate consistency, hard and runny the altered consistencies (9,18) .…”

“…Mothers of children seen for functional constipation at gastroenterology clinics often recall early onset of their child's symptoms (1,3,11,15,20,21,24,31,35) , and in Botucatu Medical School pediatric gastroenterology outpatient unit a long time gap was observed between the recalled onset of symptoms and first attendance, respectively at median 3 and 53 months of age (18) . But, data may be biased by the reliability of maternal recall after a long time lapse and by referral of the most severe cases.…”

“…More reliable information concerning early onset of constipation could be obtained in community studies, but prevalence surveys including infants/young children or specifically addressing them are scarce and, besides, some were performed in primary health clinics: these surveys (2,5,12,16,22) detected high prevalence of constipation in Brazil (18%-26.8%) and in Canada (16%), but only 4.5% in USA. In other studies, young children's bowel habit (BH) was recalled (25,38) or recorded (23,37) , but the prevalence of constipation or diarrhea was not reported, since frequency and characteristics of stools are used for classification of the BH (9,18,27,28) , and these studies considered defecation frequency apart from hard or runny stool occurrence.…”