Monitoring
Since relapses are common and bowel movement difficulty may persist
into adolescence follow-up plan of children and their parents should be
individualized, tailored based on the child’s treatment response measured by
consistency, frequency, and amount of stool. Preventive measures are discussed
for relapse of constipation.
Constipation in children that meet all the
below criteria should be categorized as refractory constipation:
- Rome IV criteria for functional constipation met
- Treatment failure after 3 months using conventional therapies which include stimulant laxative (eg Bisacodyl, Linaclotide, Prucalopride, etc), behavioral interventions and biochemical interventions (eg correct position on toilet)
- Persistent symptoms that include ≤2 voluntary defecations per week and/or ≥1 episode of fecal incontinence per week
- Impaired quality of life for the patient or family due to constipation symptoms
Further Studies
Patients with refractory constipation may
undergo further laboratory exams that include serologic screening for celiac
disease and screening tests for thyroid disease. Various imaging studies such
as abdominal X-ray, colonic transit studies via radiopaque markers, colonic
scintigraphy (if radiopaque markers are unavailable or contraindicated), lumbar
spine MRI, contrast enema, defecography and transabdominal ultrasound may also
be considered, depending on the symptoms of the patient.
Timing
Parents and guardians of infants <6 months
with functional constipation are advised to bring the patient for follow-up
after 2-4 weeks, and infants ≥6
months with functional constipation without fecal impaction after 2 weeks for
re-evaluation and evaluation of treatment efficacy.
Prognosis
In a recent systematic review, the majority of children with constipation recover within 6-12 months of starting treatment. Recovery rate is not related to age of onset, frequency of bowel movement, positive family history, and presence of fecal incontinence. Another study noted that less than half of affected children continued to be symptomatic beyond puberty with associated several complications. Relapse rate is high as functional constipation is difficult to treat. Lastly, underlying organic disorders exacerbate constipation resulting in difficult long-term management.