Constipation in Children Differential Diagnosis

Differential Diagnosis

Hirschsprung disease is the most common cause of obstruction in the lower intestines in neonates and is a rare cause of difficult-to-control constipation in children ≥2 years of age. It is suspected when the following are present such as meconium passage ≥48 hours after birth, small stools, failure to thrive, fever, bloody diarrhea, bilious vomiting, tight anal sphincter, and palpable fecal mass in the abdomen with empty rectum.  

Spinal cord abnormalities include spinal cord tumor and tethered cord. They may be considered if there is a presence of decreased lower extremity reflexes or muscular tone, negative anal wink, positive pilonidal dimple or hair tuft. Hypothyroidism is suspected if there is fatigue, intolerance to cold, slow heart rate or poor growth. Diabetes insipidus may be considered if there is increased urination and thirst. Cystic fibrosis is suspected if there is diarrhea, failure to thrive, rash, fever, and recurrent pneumonia. Lastly, anal abnormalities or anorectal anomalies like congenital anorectal malformation, imperforate anus, anal atresia, and anal stenosis, are suspected if there are findings of abnormal position or appearance of the anus.

Other diagnoses should be ruled out as well:

• Presacral masses
• Lead intoxication
• Meningomyelocele
• Cerebral palsy
• Infant dyschezia
• Cow’s milk intolerance
• Dyssynergic defecation