Evaluation and Management of Intractable Constipation in Children

Document Type : Review Article

Authors

1 Seattle Children’s Hospital, Seattle, United State

2 Boston Children’s Hospital, Boston, United States

Abstract

Intractable constipation has a negative impact on quality of life and well-being of children. The evaluation includes a thorough
history and physical examination with diagnostic testing to rule out metabolic, systemic, anatomic, and neurological etiologies. In
children with refractory symptomswhofailed aggressive medical management, colonic transit studies help guide need for invasive
testing. Manometric testing of the anorectum and the colon are recommended to evaluate for enteric neuromuscular compromise
and guide novel medical and surgical therapies. Goals of management are to facilitate colonic emptying, ensure fecal continence,
and preserve colonic neuromuscular integrity. Treatments range from aggressive medical therapy with stimulant laxatives that
modify transit to antegrade continence enemas that facilitate colonic emptying. Surgery, including diverting ostomy and resection,
has a limited role and should only be considered in select patients after medical and manometric evaluation. The aim of this article
is to provide an update on the evaluation and management of childhood intractable constipation.

Keywords