ABSTRACT
Constipation has a significant impact on a child’s quality of life and on health care costs. The estimated medical care cost of a child with constipation per year is three times that of children without constipation. Children with constipation present with infrequent and/or painful passage of hard stools with or without fecal incontinence. The pathophysiology of constipation is multi-factorial; the two major categories are functional and organic. Functional constipation can result from a delay in colonic transit, abnormal sensation, or disordered anorectal function. The most common etiology in children is stool withholding that is triggered by an unpleasant experience having a bowel movement, leading to a vicious cycle of worsening rectal pain and constipation. A contrast enema is useful to identify anatomic abnormalities and to evaluate the rectosigmoid caliber in patients with chronic constipation with fecal incontinence refractive to medical management. Little data exist regarding safety profile of laxatives in short- and long-term treatment of constipation.
