Constipation in Children Disease Background

Introduction

Constipation is defined as a delay or difficulty in bowel movement persisting for ≥2 weeks causing significant distress. It is a common digestive problem, but not a disease and usually not serious. 

Epidemiology

Constipation in children generally first occurs in the toddler stage, between ages 2 and 4 years. The prevalence of constipation in children has been estimated to be as high as 30% worldwide. Constipation in children accounts for 3% of all primary care physician visits, and up to 25% of referrals to pediatric gastroenterologists. It is a global health problem with both developed and developing countries showing high prevalence. Functional constipation is the most common cause of constipation, accounting for >95% of constipation cases. There is no difference in the prevalence of functional constipation between girls and boys.

Pathophysiology

Constipation usually starts with the transition to solid foods, toilet training, or on school entry. Constipation leads to painful bowel movements, which then lead to the child withholding the stool. In turn, withholding stool increases colonic water absorption, making the stool firmer and more difficult to pass. Over time, fecal retention stretches the rectum, which decreases the urge to defecate. Finally, the accumulation of stool in the rectum leads to a decrease in gastric emptying, resulting in abdominal distention, nausea, and loss of appetite. 

Risk Factors

Factors that may cause constipation:

• Pain
• Dehydration
• Psychological issues (eg depression, attention-deficit disorder, sexual abuse)
• Toilet training
• Fever
• Dietary and fluid intake
• Cow’s milk protein allergy
• Medicines (eg opioids, antidepressants, anticholinergics)
• Family history of constipation
• Withholding that may result from ignoring the urge to defecate due to toilet phobia, being too busy, toilet unavailability, and pain from bowel movement
• Changes in routine (eg travel, stress, hot weather)
• Medical conditions (eg intestinal, rectal or anal, metabolic or endocrine diseases)

Classification

Types of Constipation  

Functional or idiopathic constipation is the type of constipation that cannot be explained by any anatomical, physiological, radiological, or histological abnormalities. In organic constipation, constipation is associated with an identifiable physiological or organic cause and there is a presence of red and/or amber flags. Lastly, chronic constipation is constipation lasting for more than 8 weeks.