Functional Constipation in Children

Abstract

Constipation is a common and bothersome problem in children. It may present with infrequent bowel movements with fecal incontinence, hard stools, large stools, painful defecation, and abdominal pain [ 1 ]. In approximately 95 % of children with constipation, no organic cause can be identifi ed, these children suffer from functional constipation (FC) [ 2 ]. The prevalence of FC ranges between 0.7 and 29.6 % and it occurs more often in girls than in boys (ratio: 2.1:1) [ 3 ]. The diagnosis of FC is based on the pediatric diagnostic Rome criteria for functional gastrointestinal disorders (Table 42.1 ) [ 4 ]. These criteria were revised in the spring of 2016 [ 5 , 6 ] (for more information, see Benninga et al.: http:// www.ncbi.nlm.nih.gov/pubmed/27144631 or Hyams et al.: http://www.ncbi.nlm.nih.gov/pubmed/27144632 . Physiology Meconium Passage and Defecation FrequencyIn more than 99 % of healthy term neonates, the fi rst meconium passes within the fi rst 48 h of life [ 5 , 6 ]. Delayed passage of the fi rst meconium beyond the fi rst 48 h of life is suggestive for an organic defecation disorder (e.g., Hirschsprung's disease). During the fi rst months of life, the defecation frequency may vary from child to child, this is partially dependent on feeding type; breastfed children have a higher defecation frequency than formula-fed infants [ 6 ].In the fi rst weeks of life, the defecation frequency lies around 4 stools a day, this frequency gradually decreases over time until it is approximately once a day in children at the age of 4 years [ 6 , 7 ]. In older children, defecation usually occurs either daily or every other day [ 8 ]. Defecation DynamicsThe physiological dynamics of defecation are complex and rely on several intricate processes involving the autonomic and somatic nervous system, the pelvic fl oor muscles, and the internal and external anal sphincters. In the colon, feces is propelled by propagating colonic contractions. Several different colonic motor patterns have been described [ 9 , 10 ], but the most well-recognized propagating motor patterns are high-amplitude propagating contractions (HAPCs ). These motor patterns are associated with the mass movement of colonic content and spontaneous defecation in healthy adults [ 11 , 12 ]. Anterograde propagation of feces through the colon leads to fi lling of the rectum, which induces a relaxation of the internal anal sphincter, allowing feces to travel further down the anal canal; this refl ex is known as the recto-anal inhibitory refl ex (RAIR ). Subsequently, sensory stimuli caused by rectal distension and by the contact between fecal material and the mucosa of the proximal part of the anal canal result in an urge to defecate. At this point, voluntary contraction of the external anal sphincter can postpone defecation, by moving the fecal load back, higher up in the anal canal and rectum, until the place and time are appropriate for defection. When defecation is initiated, voluntary relaxation of the external anal sphincter and the pelvic fl oor musculature (...

Synbiotics in the Management of Pediatric Gastrointestinal Disorders

“…Two systematic reviews that included synbiotic treatment in functional constipation, published in 2016 and in 2021 (27,28), identified only 2 RCTs. The first was from Khodadad et al that used a combination of probiotics with no strain specification ( L. casei , L. rhamnosus , S. thermophilus , B. breve , L. acidophilus , B. infantis at the dose 1 × 10 9 CFU/1 sachet), and FOS (dose not mentioned) (29).…”

Biofeedback Therapy in Children with Functional Constipation in Tehran, Iran

“…This accumulation takes place after a painful experience of difficult defecation, and the child learns to prevent defecation by contracting the pelvic floor muscles due to fear of pain (2). Since constipation is a chronic disorder, it can cause behavioral and cognitive complications, academic failure, psychological stresses for children and their families, and finally, reduces the quality of life (12,13). Common treatments of constipation are behavioral therapies and prescribing laxatives and enema (14,15).…”