Constipation
Robert A. Nordgren
Approach to the Patient with Constipation
I. Definition of the Complaint
Constipation, a common problem in childhood, accounts for 10% to 25% of all
referrals to pediatric gastroenterologists. Although constipation is usually
characterized by the painful passage of hard stool, the term refers to both the
consistency and the frequency of stools. The precise definition of constipation
is difficult because the normal stooling pattern differs among individuals and
varies by age. The frequency of stools in most children decreases from a mean
of four per day in the first week of life, to two per day by 16 weeks of age,
and one stool per day at 4 years of age.
All cases of constipation involve a failure to evacuate the lower colon
completely with a bowel movement. A child who has two small stools per day may
not have evacuated the colon, whereas a child who has two large stools weekly
may not be constipated. The child who has experienced pain with defecation may
aggressively contract the external sphincter to prevent expulsion of stool when
the urge to defecate arises. In such cases, increased amounts of stool collect
in the rectum, and over a period of weeks to months the rectum gradually
dilates, becoming less capable of peristaltic activity.
II. Complaint by Cause and Frequency
Although functional fecal retention is the most common cause of childhood
constipation, a number of other causes must be considered in the differential
diagnosis (Table 12-1).
III. Clarifying Questions
A diagnosis of constipation can readily be made by the history and physical
examination findings. However, attention needs to be paid to certain historical
details. The following questions may provide clues to the diagnosis:
• What is the stool consistency, caliber, and volume?
— Small, pellet-like stools indicate incomplete evacuation. Intermittent, massive
stools are characteristic of functional fecal retention.
• Did the child have a bowel movement in the first 24 hours of life?
— In a child with constipation, failure to pass melonium in the first 24 to 48
hours of life increases the likelihood of Hirschsprung
's disease.
• Were there any neonatal complications or prior surgeries?
— Neonatal gastrointestinal complications such as necrotizing enterocolitis or
prior surgery can lead to strictures or adhesions and predispose a child to
constipation and small-bowel obstruction.
• Is the child going through any transitions such as changes from breast- to
bottle-feeding, diapers to toilet training, or home care to childcare center or
school?
— Developmental and social transition periods are the most common times for
functional constipation to begin. Asking about transitions such as a move into
childcare can help identify a possible cause of constipation and can also give
parents insight into the diagnosis.
• Is there a history of sexual abuse?
— The emotional trauma of sexual abuse can predispose a child to constipation.
• Is the child taking any medications?
— Several medications can cause constipation (Table 12-1).
• Are there any other symptoms (e.g., fever, blood in stool)?
— Symptoms associated with constipation point to an organic cause.
• Has the family kept a journal of the child's stooling patterns and diet?
— A 5- to 7-day journal of stooling patterns and diet can help both the clinician
and the family objectively assess the true extent of constipation. A diet
history can help identify a cause of constipation and also can serve as a
starting point for therapy for functional constipation.
Pictures
Book Source Details
- Book Title: Pediatric Complaints and Diagnostic Dilemmas
- Author(s): Samir S Shah MD; Stephen Ludwig MD
- Year of Publication: 2003
- Copyright Details: Pediatric Complaints and Diagnostic Dilemmas, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Constipation
Read excerpts from these other book chapters related to Constipation:
Medical Books Excerpts
- Constipation
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Constipation
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Constipation
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
Copyright Details: Pediatric Complaints and Diagnostic Dilemmas, Copyright © 2008 Williams & Wilkins.
More About Causes of Constipation
» Next page: Constipation (The 5-Minute Pediatric Consult)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
