Treatment options for refractory childhood constipation

Abstract

Constipation in children is very common. Childhood constipation responds successfully to medical therapies, behavioral modifications, or a combination of both in approximately 70% of children within 2 years of diagnosis. Persistence of constipation is associated with fecal incontinence, recurrent fecal impactions, and significant emotional problems. Refractory constipation that interferes with both the child's function and the family's life requires extensive evaluations in order to uncover its cause and devise appropriate therapeutic strategies. Children with persistent constipation can be divided into three broad categories: 1) those who have functional constipation, 2) those affected by enteric neuromuscular disorders, and 3) those whose constipation is associated with neurologic handicaps. Treatment options vary widely. The majority of patients require more aggressive medical and more intense behavioral interventions. Others benefit from novel approaches, including surgical intervention.

Laparoscopic seromuscular colonic biopsies: a surgeon's experience

“…The recognition that paediatric chronic constipation is likely to result from abnormalities within the neuromuscular component of the colonic wall has followed [4,11,12]. At our institution, laparoscopic seromuscular colonic biopsies were developed to study a depth of the bowel wall that colonoscopic biopsies were incapable of obtaining.…”

Pilot study using transcutaneous electrical stimulation (interferential current) to treat chronic treatment‐resistant constipation and soiling in children

“…Constipation is a common problem in clinical pediatrics, with 70% of children responding to treatment based on laxatives and behavioral modification 1,2 . The remaining children have chronic treatment‐resistant constipation.…”

“…Constipation is a common problem in clinical pediatrics, with 70% of children responding to treatment based on laxatives and behavioral modification. 1,2 The remaining children have chronic treatment-resistant constipation. Chronic treatment-resistant constipation can be due to behavior/learning disorders, outlet obstruction or slow transit through the colon.…”

Nuclear transit studies of patients with intractable chronic constipation reveal a subgroup with rapid proximal colonic transit

“…Children with normal proximal colonic transit and anorectal retention usually respond to standard medical therapies using laxatives, toileting program, behavioral modifications, and biofeedback therapy [26,27]. Slow colonic transit characterizing slow-transit constipation is more difficult to treat because they do not respond to standard medical therapies [28][29][30], but recent studies with transcutaneous electrical stimulation using interferential current offer hope by improving colonic transit and quality of life [31][32][33].…”