Cargando…
Paediatrics: how to manage functional constipation
BACKGROUND: Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation. METHODS: A PubMed search was performed with Clinical Queri...
Autores principales: | , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioExcel Publishing Ltd
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007206/ https://www.ncbi.nlm.nih.gov/pubmed/33828605 http://dx.doi.org/10.7573/dic.2020-11-2 |
_version_ | 1783672448123666432 |
---|---|
author | Leung, Alexander KC Hon, Kam Lun |
author_facet | Leung, Alexander KC Hon, Kam Lun |
author_sort | Leung, Alexander KC |
collection | PubMed |
description | BACKGROUND: Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation. METHODS: A PubMed search was performed with Clinical Queries using the key term ‘functional constipation’. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and to the paediatric population. The information retrieved from the above search was used in the compilation of the present article. RESULTS: A detailed history and thorough physical examination are important in the evaluation of a child with constipation to establish the diagnosis of functional constipation as per the Rome IV criteria and to catch ‘red flags’ suggestive of organic causes of constipation. These ‘red flags’ include delayed passage of meconium, ribbon stool, rectal bleeding/blood in the stool unless attributable to an anal fissure, failure to thrive, severe abdominal distension, absent anal wink/cremasteric reflex, tight and empty rectum on digital examination and explosive expulsion of liquid stool and gas on withdrawal of the finger, hair tuft/dimple/lipoma/haemangioma in the lumbosacral area, and an anteriorly displaced anus. For functional constipation, pharmacological therapy consists of faecal disimpaction and maintenance therapy. This can be effectively accomplished with oral medications, rectal medications or a combination of both. The most commonly used and most effective laxative is polyethylene glycol. Non-pharmacological management consists of education, behavioural modification and dietary interventions. The combination of pharmacological therapy and non-pharmacological management increases the chance of success. CONCLUSION: Polyethylene glycol is the medication of first choice for both disimpaction and maintenance therapy. If polyethylene glycol is not available or is poorly tolerated, lactulose is the preferred alternative. Other laxatives may be considered as second-line therapy if treatment with osmotic laxatives fails or is insufficient. Maintenance treatment should be continued for at least 2 months. Early treatment will result in a faster and shorter treatment course. |
format | Online Article Text |
id | pubmed-8007206 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioExcel Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-80072062021-04-06 Paediatrics: how to manage functional constipation Leung, Alexander KC Hon, Kam Lun Drugs Context Review BACKGROUND: Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation. METHODS: A PubMed search was performed with Clinical Queries using the key term ‘functional constipation’. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and to the paediatric population. The information retrieved from the above search was used in the compilation of the present article. RESULTS: A detailed history and thorough physical examination are important in the evaluation of a child with constipation to establish the diagnosis of functional constipation as per the Rome IV criteria and to catch ‘red flags’ suggestive of organic causes of constipation. These ‘red flags’ include delayed passage of meconium, ribbon stool, rectal bleeding/blood in the stool unless attributable to an anal fissure, failure to thrive, severe abdominal distension, absent anal wink/cremasteric reflex, tight and empty rectum on digital examination and explosive expulsion of liquid stool and gas on withdrawal of the finger, hair tuft/dimple/lipoma/haemangioma in the lumbosacral area, and an anteriorly displaced anus. For functional constipation, pharmacological therapy consists of faecal disimpaction and maintenance therapy. This can be effectively accomplished with oral medications, rectal medications or a combination of both. The most commonly used and most effective laxative is polyethylene glycol. Non-pharmacological management consists of education, behavioural modification and dietary interventions. The combination of pharmacological therapy and non-pharmacological management increases the chance of success. CONCLUSION: Polyethylene glycol is the medication of first choice for both disimpaction and maintenance therapy. If polyethylene glycol is not available or is poorly tolerated, lactulose is the preferred alternative. Other laxatives may be considered as second-line therapy if treatment with osmotic laxatives fails or is insufficient. Maintenance treatment should be continued for at least 2 months. Early treatment will result in a faster and shorter treatment course. BioExcel Publishing Ltd 2021-03-26 /pmc/articles/PMC8007206/ /pubmed/33828605 http://dx.doi.org/10.7573/dic.2020-11-2 Text en Copyright © 2021 Leung AKC, Hon KL. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission. |
spellingShingle | Review Leung, Alexander KC Hon, Kam Lun Paediatrics: how to manage functional constipation |
title | Paediatrics: how to manage functional constipation |
title_full | Paediatrics: how to manage functional constipation |
title_fullStr | Paediatrics: how to manage functional constipation |
title_full_unstemmed | Paediatrics: how to manage functional constipation |
title_short | Paediatrics: how to manage functional constipation |
title_sort | paediatrics: how to manage functional constipation |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007206/ https://www.ncbi.nlm.nih.gov/pubmed/33828605 http://dx.doi.org/10.7573/dic.2020-11-2 |
work_keys_str_mv | AT leungalexanderkc paediatricshowtomanagefunctionalconstipation AT honkamlun paediatricshowtomanagefunctionalconstipation |