Paediatricians' approach to constipation

Abstract

Constipation in childhood is common, accounting for 3% of general paediatric referrals and up to 25% of referrals to paediatric gastroenterology centres. Although common, it is a poorly understood condition and often responds poorly to treatment. Unfortunately there is no standard definition of constipation which is generally taken to mean a decreased frequency, harder consistency, and subjective difficulty in passing a bowel movement. The term soiling refers to involuntary seepage of faeces and implies overflow incontinence associated with faecal impaction. Encopresis implies the voluntary or involuntary passage of an ordinary bowel movement into the clothing or other abnormal place after the age of 4 years and occurring on a regular basis without any organic cause. In the great majority of cases of constipation no organic cause can be demonstrated (see Table 1). It is important to realise that primary psychological problems are not more common in children with constipation than in the general population; in one large study only 20% of patients had any identifiable psychological problems whatsoever. 1 Similarly, most recent studies indicate that there is no evidence to suggest a primary psychological problem even in encopretic children. 1-3