Constipation
Leah Harrington
Introduction
Constipation: < 3 bowel movements/week, and/or painful passage of hard/large stools
Functional constipation: not due to organic, anatomic, or pharmaceutical causes
Fecal soiling: stool deposited on underwear regardless of presence of organic/anatomic lesion
Encopresis: fecal soiling with functional constipation in the child 4 years of age
Differential Diagnosis
Gastroenteritis, urinary tract infection, intussusception, appendicitis, chronic recurrent abdominal pain
Acute (1-4 weeks)
Most common etiologies: viral illness, dietary change
Chronic (> 4 weeks)
Functional
Organic/mechanical obstruction (e.g., Hirschsprung’s)
Drug induced (e.g., iron supplementation)
Endocrine (e.g., hypothyroidism)
Neuromuscular disorders (e.g., cerebral palsy)
Clinical Presentation
Affects all age groups
One of the most common causes of pediatric abdominal pain
Important questions: passage of meconium within the first 24 hours of life, description of stools, medications taken, recent viral illness
Examination
Acutely Constipated Child
Well hydrated/nourished
May have significant pain causing the child to draw the legs into the abdomen
Chronically Constipated Child
As above if functional etiology
May present with failure to thrive or unwell/toxic if secondary to organic/obstructive processes
Abdominal Examination
Stool may be palpated; abdomen is generally soft, diffusely tender with lack of peritoneal signsRelated posts:
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