The care of constipated children in primary care in different countries

Abstract

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.

Prevalence, Clinical Characteristics, and Management of Functional Constipation at Pediatric Gastroenterology Clinics

“…First, its etiology in children has not been fully understood. Many primary care physicians hypothesized the withholding of stools after an experience of painful BMs as the main pathophysiology of constipation (7, 8, 12). Various factors were assumed to affect constipation such as low fiber intake, anorexia, or lack of exercise and/or low body weight per height (16).…”

“…Many primary care physicians have considered low fiber or fluid intake as a main cause of constipation, in addition to stool withholding (12). In our study, parents have less considered stool withholding as a key cause for constipation than physicians, unlike western countries.…”

“…The NASPGHAN constipation guidelines emphasized the importance of taking a thorough history and physical examination, and using the disimpaction method as an initial treatment (19). At clinics, some primary care physicians (31%-51%) reported to have conducted a rectal examination for some patients (20%) as a diagnostic tool for constipation (12, 20). All physicians recommended more fiber intake but only some referred patients to a dietitian (12).…”

“…Another is general public misconceptions or dissatisfaction on the constipation management which might have contributed to a reluctance to seek a professional care, only using home remedy, and incompliance with a treatment regimen (9-11). Even though constipation can be resolved using multidisciplinary approaches, currently there have been no consistent treatment guidelines in Korea (12). …”

Transabdominal electrical stimulation (TES) for the treatment of slow-transit constipation (STC)

“…General guidelines for the treatment of constipation include removal of faecal impaction before initiation of maintenance therapy with education on toileting, use of laxatives and dietary modification to include more water and unprocessed foods [66][67][68][69][70][71]. We have added this treatment before TES and found that there is a greater increase in defecation frequency.…”