Materiały źródłowe

• #1 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3042216/

  Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. Alteration of rectal and pelvic floor function through the brain-gut axis seems to play a crucial role in the etiology. […] The pathophysiology of constipation in children is multi-factorial and is associated with interactions of many risk factors. Many organic diseases cause constipation. However, the majority of constipation patients secondary to organic conditions usually have other clinical features suggestive of the relevant underlying organic disease. Organic diseases presenting as isolated constipation are rather uncommon. […] Over 90% of children with this condition have functional constipation. Borowitz et al reported painful defecation as the commonest factor for constipation. If there is pain during defecation, children usually withhold stools. During the withholding, rectal mucosa absorbs water from the fecal mass, which becomes harder and larger as the time passes and ultimately defecation becomes difficult. Therefore, when the desire to pass stools comes, children adopt retentive posture, hide from parents till the urge pass off.

• #2 Functional constipation in children: What physicians should know

  https://www.wjgnet.com/1007-9327/full/v29/i8/1261.htm

  Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. […] Its pathophysiological mechanisms are thought to be multifactorial and complicated, resulting in difficult management. […] The etiology of constipation can be classified into functional and organic causes, which account for 90% and 10% of the cases, respectively. […] Regarding FC, the pathophysiological mechanism might be multifactorial, including stool withholding behavior, anorectal dysfunctions, diet, physical activity, genetic predisposition, and psychological issues. […] Stool withholding behavior is the main pathophysiological mechanism especially in toddlers and young children.

• #3 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?volume=17&number=1&spage=35

  Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management […] Constipation is one of the commonest digestive complaints in children, which has recently grown to quite a proportion in public health problem. […] Like many other functional disorders, its etiology, pathophysiology and prognosis are ill-understood. […] The pathophysiology of constipation in children is multi-factorial and is associated with interactions of many risk factors. […] Over 90% of children with this condition have functional constipation. […] Borowitz et al reported painful defecation as the commonest factor for constipation. […] If there is pain during defecation, children usually withhold stools. […] During the withholding, rectal mucosa absorbs water from the fecal mass, which becomes harder and larger as the time passes and ultimately defecation becomes difficult.

• #4 The ten “hard” questions in pediatric functional constipation | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01623-y

  Functional constipation is a common problem in childhood and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. No organic cause of the constipation can be found in approximately 95% of children, defining the so-called chronic functional constipation. Its prevalence has been reported to range from 0.7 to 29.6%, with a median of 12%. The diagnosis of functional constipation is exclusively clinical based on the pediatric diagnostic Rome criteria for functional gastrointestinal disorders and does not routinely require laboratory and/or radiological investigations. […] Pathophysiology of FC is multifactorial but the stool withholding behavior seems to be the main etiological agent. […] The main pathophysiological mechanism, especially in toddlers and young children, is the stool retention behavior. Retention of stool in the rectum causes water to be absorbed by the rectal mucosa resulting in increasingly lumpy and hard stools. This process leads to a vicious cycle of difficult defecation. Furthermore, if large stools are retained in the rectum, the rectal wall can become more and more distended resulting in fecal overflow incontinence, loss of rectal sensation, and loss of the normal urge to defecate.

• #5 Unraveling childhood constipation: Pathophysiology, diagnostics and treatment

  https://dare.uva.nl/personal/pure/en/publications/unraveling-childhood-constipation-pathophysiology-diagnostics-and-treatment(e3406df8-0d2d-4aea-8390-25197612f241).html

  Constipation represents a common worldwide problem in children. In 90% of children presenting with constipation, no obvious organic cause is found and a diagnosis of functional constipation (FC) is made. The underlying pathophysiology of childhood constipation is multi-factorial, remains poorly understood, which makes treatment of these patients challenging. Therefore, the focus of this thesis is to unravel the pathophysiology, to improve diagnostic strategies and to discover new treatment options for childhood constipation.

• #6 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?volume=17&number=1&spage=35

  Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management […] Constipation is one of the commonest digestive complaints in children, which has recently grown to quite a proportion in public health problem. […] Like many other functional disorders, its etiology, pathophysiology and prognosis are ill-understood. […] The pathophysiology of constipation in children is multi-factorial and is associated with interactions of many risk factors. […] Over 90% of children with this condition have functional constipation. […] Borowitz et al reported painful defecation as the commonest factor for constipation. […] If there is pain during defecation, children usually withhold stools. […] During the withholding, rectal mucosa absorbs water from the fecal mass, which becomes harder and larger as the time passes and ultimately defecation becomes difficult.

• #7 Functional constipation in children: What physicians should know

  https://www.wjgnet.com/1007-9327/full/v29/i8/1261

  Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. […] The etiology of constipation can be classified into functional and organic causes, which account for 90% and 10% of the cases, respectively. […] Regarding FC, the pathophysiological mechanism might be multifactorial, including stool withholding behavior, anorectal dysfunctions, diet, physical activity, genetic predisposition, and psychological issues. Stool withholding behavior is the main pathophysiological mechanism especially in toddlers and young children. […] Faulty toilet training, painful defecation from hard stool and frequent rectal enema contribute to fear and bad experiences related to defecation, which can cause purposeful or subconscious stool withholding behavior.

• #8 Pediatric Constipation: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/928185-overview

  Most children suffering from constipation have no underlying medical condition. […] In most cases, childhood constipation develops when the child begins to associate pain with defecation. Once pain is associated with the passage of bowel movements, the child begins to withhold stools in an attempt to avoid discomfort. […] Chronic rectal distention ultimately results in both loss of rectal sensitivity, and loss of the urge to defecate, which can lead to fecal incontinence (ie, encopresis).

• #9

• #10 Constipation in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242

  Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract, causing the stool to become hard and dry. […] Many factors can contribute to constipation in children, including: […] Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience. […] If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that’s tough to change. […] Not enough fiber-rich fruits and vegetables or fluid in your child’s diet may cause constipation. […] Any changes in your child’s routine such as travel, hot weather or stress can affect bowel function. […] Rarely, constipation in children indicates an anatomic malformation, a metabolic or digestive system problem, or another underlying condition.

• #11 Functional constipation in children: What physicians should know

  https://www.wjgnet.com/1007-9327/full/v29/i8/1261.htm

  Faulty toilet training, painful defecation from hard stool and frequent rectal enema contribute to fear and bad experiences related to defecation, which can cause purposeful or subconscious stool withholding behavior. […] This behavior promotes the retention of stool in rectum and causes the stool to become lumpier and harder, making it quite difficult to evacuate, due to water absorption by rectal mucosa. […] This phenomenon leads to a vicious cycle of difficult defecation. […] Once large stools are retained in the rectum, the rectal wall stretches and develops into a megarectum with decreased sensation to defecate. […] Hence, two of the three characteristics were integrated into the Rome IV criteria.

• #12 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Constipation in children is usually functional constipation without an organic cause. Organic causes of constipation in children, which include Hirschsprung disease, cystic fibrosis, and spinal cord abnormalities, commonly present with red flag signs and symptoms. […] Constipation leads to painful bowel movements, which can cause the child to withhold stool. Withholding stool increases colonic water absorption, making the stool firmer and more difficult to pass. The child contracts the anal sphincter or gluteal muscles by stiffening the body to avoid another painful bowel movement. […] Over time, fecal retention stretches the rectum, which decreases the urge to defecate. The accumulation of stool in the rectum causes a decrease in gastric emptying, resulting in abdominal distention, abdominal pain, nausea, and loss of appetite.

• #13 Pediatric Functional Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537037/

  Functional constipation is a term used to describe a condition in which patients have hard, infrequent bowel movements that are often difficult or painful to pass. […] Functional constipation does not result from an identifiable anatomic abnormality or disease process and is a diagnosis of exclusion. […] This condition can be seen in healthy children 1 year and older and is particularly common among preschool-aged children. […] Functional constipation is often described as difficult or infrequent bowel movements/ deviation from normal frequency, painful defecation, the passage of hard stools, and/or the sensation of incomplete evacuation of stool. […] It is often not caused by any underlying systemic cause or anatomical defect. […] The cycle of stool holding, removal of water from the stool, and stretching of the smooth muscles in the intestine results in hard stools that are large and painful to pass, causing further stool holding.

• #14 Pediatric Functional Constipation | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21993

  Functional constipation is commonly seen in preschool children, especially during toilet training. Although specific individuals may be more prone to constipation than others, a common cycle of events or triggers often leads to functional constipation. […] The cycle of stool holding, removal of water from the stool, and stretching of the smooth muscles in the intestine results in hard stools that are large and painful to pass, causing further stool holding. If this becomes a more chronic condition, a patients rectum fills with a hard stool on an ongoing basis, and they begin to lose the sensation of having to have a bowel movement. Soft stool often leaks around the harder plug, resulting in encopresis. […] Holding stools rather than emptying the colon leads to stool accumulation. The colon removes water from stool, making it harder and more challenging to pass.

• #15 Pathophysiology of functional constipation in children – DNB Pediatrics

  https://www.dnbpediatrics.com/2022/10/functional-constipation.html

  The pathophysiology of functional capacity in children remains unclear but is multifactorial. […] The most common mechanism for developing FC, especially in younger age group, is withholding behavior. […] All these events give rise to large, hard stool and the passage of such stools lead to stretching of the pain-sensitive anal canal. As a result of this child decides to avoid defecation. […] Withholding of feces leads to prolonged fecal stasis in the rectum, with the resultant absorption of fluids and harder stools. […] Successive retention of stools in the rectum makes them larger. […] As the cycle is repeated, successively greater amounts of larger and harder stools are built up in the rectum and passed with even greater pain accompanied by severe stool withholding maneuvers. […] Thus a vicious cycle sets in.

• #16 Functional constipation in children – evaluation and management

  https://www.termedia.pl/Functional-constipation-in-children-evaluation-and-management,41,23479,1,1.html

  Chronic constipation and soiling (encopresis) is a very common health problem among children. […] Most cases (90-95%) are functional in origin, and they are often related with multiple contributing factors (inadequate nutrition, decreased physical activity, emotional/behavioural and psychological factors), but the exact pathomechanism is still unknown. […] The most frequent cause of habitual constipation in children is definitely painful bowel movement. […] This, in turn, leads to a greater reabsorption of water through the rectal mucosa and hardening of the stool making the next bowel movement more painful. […] The vicious circle mechanism evokes and escalates additional non-specific symptoms such as abdominal distension, excessive postprandial fullness, loss of appetite, encopresis, blood and mucus in the stool, nausea, vomiting, and abnormally slow weight gain. First and foremost, this mechanism generates and enhances the fear of defecation.

• #17 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3042216/

  Accumulation of stools in rectum causes gradual dilatation leading to megarectum resulting in loss of rectal sensation and urge for defecation. It had been shown that children with megarectum have high sensory threshold for rectal sensation. […] Several studies have demonstrated slow colonic transit in 25%-69% children with constipation. Furthermore, those with slow transit constipation had more severe symptoms including night time soiling. Laparoscopic biopsies of the colon have shown deficiency of neurotransmitters such as substance P in some children. Furthermore, it was shown that number of antegrade pressure waves in the colon was significantly decreased in children with slow transit constipation.

• #18 Pathophysiology of functional constipation in children – DNB Pediatrics

  https://www.dnbpediatrics.com/2022/10/functional-constipation.html

  These children develop a stool-withholding maneuver or retentive posture which parents mistakenly think it as an attempt to defecate. […] Eventually, liquid stool from the proximal colon may percolate around these hard stools and pass per rectum involuntarily (fecal incontinence). […] With more and more stasis, the rectum becomes dilated and redundant, and the sensitivity of the defecation reflex and the effectiveness of peristaltic contractions of rectal muscles decrease. […] In some children, Functional constipation can result from low number of interstitial cells of Cajal without any other significant pathological organic findings. […] Many children with functional constipation have a positive family history. In this subgroup genetic factors may play a role. Neurodevelopmental disorders such as autism spectrum disorders (ASDs) can be associated with functional constipation resulting from lack of adequate behavioral response to a defecation sensation.

• #19 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?volume=17&number=1&spage=35

  Therefore, when the desire to pass stools comes, children adopt retentive posture, hide from parents till the urge pass off. […] Passage of this fecal mass is painful and sometimes results in anal fissures which further aggravate pain and precipitate stool withholding. […] This sets up a vicious cycle of stool retention. […] Accumulation of stools in rectum causes gradual dilatation leading to megarectum resulting in loss of rectal sensation and urge for defecation. […] It had been shown that children with megarectum have high sensory threshold for rectal sensation. […] Other intestinal pathologies leading to chronic constipation surprisingly have not received much attention. […] Several studies have demonstrated slow colonic transit in 25%-69% children with constipation. […] Furthermore, those with slow transit constipation had more severe symptoms including night time soiling. […] Laparoscopic biopsies of the colon have shown deficiency of neurotransmitters such as substance P in some children. […] Furthermore it was shown that number of antegrade pressure waves in the colon was significantly decreased in children with slow transit constipation.

• #20 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2011.17.1.35

  Therefore, when the desire to pass stools comes, children adopt retentive posture, hide from parents till the urge pass off. […] Passage of this fecal mass is painful and sometimes results in anal fissures which further aggravate pain and precipitate stool withholding. […] This sets up a vicious cycle of stool retention. […] Accumulation of stools in rectum causes gradual dilatation leading to megarectum resulting in loss of rectal sensation and urge for defecation. […] It had been shown that children with megarectum have high sensory threshold for rectal sensation. […] Several studies have demonstrated slow colonic transit in 25%-69% children with constipation. […] Furthermore, those with slow transit constipation had more severe symptoms including night time soiling.

• #21 The ten “hard” questions in pediatric functional constipation | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01623-y

  Functional constipation is a common problem in childhood and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. No organic cause of the constipation can be found in approximately 95% of children, defining the so-called chronic functional constipation. Its prevalence has been reported to range from 0.7 to 29.6%, with a median of 12%. The diagnosis of functional constipation is exclusively clinical based on the pediatric diagnostic Rome criteria for functional gastrointestinal disorders and does not routinely require laboratory and/or radiological investigations. […] Pathophysiology of FC is multifactorial but the stool withholding behavior seems to be the main etiological agent. […] The main pathophysiological mechanism, especially in toddlers and young children, is the stool retention behavior. Retention of stool in the rectum causes water to be absorbed by the rectal mucosa resulting in increasingly lumpy and hard stools. This process leads to a vicious cycle of difficult defecation. Furthermore, if large stools are retained in the rectum, the rectal wall can become more and more distended resulting in fecal overflow incontinence, loss of rectal sensation, and loss of the normal urge to defecate.

• #22 Stool Incontinence in Children – Pediatrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pediatrics/stool-incontinence-in-children/stool-incontinence-in-children

  Encopresis is most commonly caused by retentive constipation in children with behavioral and/or physical predisposing factors. […] Stool retention and constipation result in dilation of the rectum and sigmoid colon, which leads to changes in the reactivity of muscles and sensitivity of nerves of the bowel wall, particularly in the rectum. These changes decrease the efficacy of bowel excretory function and lead to further retention. […] As stool remains in the bowel, water is absorbed from the colon, which hardens the stool, making passage more difficult and painful. Softer, looser stool may then leak around the hardened stool bolus, resulting in overflow. Children typically are unable to control the overflow because of the impact on the rectum’s sensitivity. […] Both leakage and ineffective bowel control result in stool accidents.

• #23 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Constipation in children is usually functional constipation without an organic cause. Organic causes of constipation in children, which include Hirschsprung disease, cystic fibrosis, and spinal cord abnormalities, commonly present with red flag signs and symptoms. […] Constipation leads to painful bowel movements, which can cause the child to withhold stool. Withholding stool increases colonic water absorption, making the stool firmer and more difficult to pass. The child contracts the anal sphincter or gluteal muscles by stiffening the body to avoid another painful bowel movement. […] Over time, fecal retention stretches the rectum, which decreases the urge to defecate. The accumulation of stool in the rectum causes a decrease in gastric emptying, resulting in abdominal distention, abdominal pain, nausea, and loss of appetite.

• #24 Constipation in children – Wikipedia

  https://en.wikipedia.org/wiki/Constipation_in_children

  Constipation in children refers to the medical condition of constipation in children. It is a functional gastrointestinal disorder. […] The median onset of functional constipation in children is at 2.3 years old, with girls and boys being similarly affected. […] Constipation in children may present as encopresis, or the inappropriate passage of stool (usually involuntarily) in inappropriate places. […] Stool can build up in the rectum, leading to rectal dilation and decreased gastric emptying. This can present as nausea, vomiting, abdominal distention, loss of appetite and pain. […] Chronic constipation in children has been associated with urinary stasis and urinary tract infections. […] 95% of cases of constipation in children are thought to be functional constipation (without a structural or biochemical cause).

• #25 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3042216/

  Accumulation of stools in rectum causes gradual dilatation leading to megarectum resulting in loss of rectal sensation and urge for defecation. It had been shown that children with megarectum have high sensory threshold for rectal sensation. […] Several studies have demonstrated slow colonic transit in 25%-69% children with constipation. Furthermore, those with slow transit constipation had more severe symptoms including night time soiling. Laparoscopic biopsies of the colon have shown deficiency of neurotransmitters such as substance P in some children. Furthermore, it was shown that number of antegrade pressure waves in the colon was significantly decreased in children with slow transit constipation.

• #26 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?volume=17&number=1&spage=35

  Therefore, when the desire to pass stools comes, children adopt retentive posture, hide from parents till the urge pass off. […] Passage of this fecal mass is painful and sometimes results in anal fissures which further aggravate pain and precipitate stool withholding. […] This sets up a vicious cycle of stool retention. […] Accumulation of stools in rectum causes gradual dilatation leading to megarectum resulting in loss of rectal sensation and urge for defecation. […] It had been shown that children with megarectum have high sensory threshold for rectal sensation. […] Other intestinal pathologies leading to chronic constipation surprisingly have not received much attention. […] Several studies have demonstrated slow colonic transit in 25%-69% children with constipation. […] Furthermore, those with slow transit constipation had more severe symptoms including night time soiling. […] Laparoscopic biopsies of the colon have shown deficiency of neurotransmitters such as substance P in some children. […] Furthermore it was shown that number of antegrade pressure waves in the colon was significantly decreased in children with slow transit constipation.

• #27 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2011.17.1.35

  Therefore, when the desire to pass stools comes, children adopt retentive posture, hide from parents till the urge pass off. […] Passage of this fecal mass is painful and sometimes results in anal fissures which further aggravate pain and precipitate stool withholding. […] This sets up a vicious cycle of stool retention. […] Accumulation of stools in rectum causes gradual dilatation leading to megarectum resulting in loss of rectal sensation and urge for defecation. […] It had been shown that children with megarectum have high sensory threshold for rectal sensation. […] Several studies have demonstrated slow colonic transit in 25%-69% children with constipation. […] Furthermore, those with slow transit constipation had more severe symptoms including night time soiling.

• #28 Constipation pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Constipation_pathophysiology

  Primary constipation is caused by anorectal and colonic problems, while secondary constipation is caused by organic and metabolic diseases or medications. […] Diseases that disturb the nervous system may lead to constipation, such as diabetes mellitus, autonomic neuropathy, Chagas’ disease, and Hirschsprung’s disease. […] HAPCs are usually decreased in constipation and maybe the main pathophysiology of constipation. […] On molecular basis, the primary movements of the gut (peristalsis) are regulated through serotonin (5-hydroxytriptamine [5HT]). […] Primary constipation is considered when the secondary causes of constipation are ruled out. […] The slow-transit constipation is due to decreased number of interstitial cells of Cajal (ICC) and alteration of myenteric plexus neurons which secretes substance P. […] The primary defect in dyssynergia is lack of coordination among abdominal, rectoanal, and pelvic floor muscles contractions during defecation process. […] Most of medications can lead to constipation as a side effect.

• #29 Functional constipation in children: challenges and solutions | PHMT

  https://www.dovepress.com/functional-constipation-in-children-challenges-and-solutions-peer-reviewed-fulltext-article-PHMT

  The pathophysiology of FC in children remains unclear but is multifactorial. The most common mechanism for developing FC, especially in young children, is withholding behavior, often starting after a painful-frightening bowel movement. The stools remain in the rectum, the rectal mucosa reabsorbs water from the retained stools, which become more difficult to evacuate. This vicious circle can lead to fecal impaction, sometimes to overflow fecal incontinence, loss of rectal sensation, and ultimately, loss of normal urge to defecate. […] In a subgroup of children, FC can be due to slow transit. The interstitial cells of Cajal play an important role in the motility of the gut. These cells can be regarded as pacemakers that generate peristalsis in the gut. Many publications report consistent histological findings in children with all forms of constipation of a low number of interstitial cells of Cajal, although the normal number of interstitial cells of Cajal in healthy children remains unclear.

• #30 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3042216/

  Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. Alteration of rectal and pelvic floor function through the brain-gut axis seems to play a crucial role in the etiology. […] The pathophysiology of constipation in children is multi-factorial and is associated with interactions of many risk factors. Many organic diseases cause constipation. However, the majority of constipation patients secondary to organic conditions usually have other clinical features suggestive of the relevant underlying organic disease. Organic diseases presenting as isolated constipation are rather uncommon. […] Over 90% of children with this condition have functional constipation. Borowitz et al reported painful defecation as the commonest factor for constipation. If there is pain during defecation, children usually withhold stools. During the withholding, rectal mucosa absorbs water from the fecal mass, which becomes harder and larger as the time passes and ultimately defecation becomes difficult. Therefore, when the desire to pass stools comes, children adopt retentive posture, hide from parents till the urge pass off.

• #31 The ten “hard” questions in pediatric functional constipation | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01623-y

  The etiology of FC remains unknown, but it seems to be multifactorial: genetic factors, lifestyle factors (e.g., diet and physical activity), and psychological disorders are likely to be involved. In particular, a crucial role seems to be played by the alteration of the rectal and pelvic floor functions through the brain-gut axis. […] Changes in routine or diet, weaning, stressful events, entering kindergarten, intercurrent illnesses and even school can contribute to the problem. […] It is commonly believed that a low-fiber diet contributes to constipation. Actually, the literature on this issue is still conflicting. […] Recent evidence demonstrates that FC may be the result of alterations of intestinal microbiota and microbiota-gut-brain axis. […] The composition of gut microbiota in infants depends on delivery mode and cesarean delivery was associated with high risk of FC.

• #32

  https://link.springer.com/article/10.1007/s40272-023-00563-0

  Other factors that have been suggested to play a role in the development of FC are socioeconomic status, specific parental child-rearing attitudes, genetics, lifestyle, diet, the gut microbiome, and colonic dysmotility. […] The first step in treating FC involves education, demystification, lifestyle advice, and toilet training (when developmental age is at least 4 years). […] The pathophysiology of FC is considered to be multifactorial, and withholding behavior plays a major role.

• #33 Constipation in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242

  Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract, causing the stool to become hard and dry. […] Many factors can contribute to constipation in children, including: […] Painful bowel movements caused by large, hard stools also may lead to withholding. If it hurts to poop, your child may try to avoid a repeat of the distressing experience. […] If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that’s tough to change. […] Not enough fiber-rich fruits and vegetables or fluid in your child’s diet may cause constipation. […] Any changes in your child’s routine such as travel, hot weather or stress can affect bowel function. […] Rarely, constipation in children indicates an anatomic malformation, a metabolic or digestive system problem, or another underlying condition.

• #34 Constipation (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/constipation.html

  Constipation can be due to a diet that doesn’t include enough water and fiber, which help the bowels move as they should. […] Stress also can lead to constipation. Kids can get constipated when they’re anxious about something, like starting at a new school or problems at home. Research has shown that emotional upsets can affect how well the gut works and can cause constipation and other conditions, like diarrhea. […] Some kids get constipated because of irritable bowel syndrome (IBS), which can happen when they’re stressed or eat certain trigger foods, which often are fatty or spicy. A child with IBS may have either constipation or diarrhea, as well as stomach pain and gas.

• #35 SciELO Brasil – Functional constipation in children Functional constipation in children

  https://www.scielo.br/j/jped/a/Bczrffvykq57FtKrq4YY3NB/

  A too low fiber intake is a well-known cause of functional constipation. In theory, fiber may have a negative effect on functional constipation if the pathophysiologic mechanism behind is withholding behavior and in cases of insufficient water intake. In cases of withholding behavior, the colon has more time to absorb the water from the fecal bulk, increasing the volume of the dry material, and thus aggravating functional constipation symptoms, such as pain at defecation. […] In conclusion, green banana biomass has been shown to be effective in the management of functional constipation and to decrease the need for laxatives.

• #36 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2014.17.4.203

  Higher dietary fiber intake (fruits, legumes, and vegetables) is associated with a lower incidence of constipation in some studies. […] However, the water-soluble fiber (psyllium and glucomannan) results are conflicting. […] Against common sense that drinking water is helpful for constipation, many well-known studies, including the 2014 ESPGHAN and ESPGHAN paper, insist that no evidence supports the use of extra fluid intake to treat functional constipation. […] The proposed probiotic mechanism for constipation involves 1) Bifidobacteria and lactobacilli produce lactic acid, acetic acid, and other acids, which lower pH in the colon and enhance peristalsis. […] Dysbiosis of intestinal flora, high frequencies of Clostridium and Enterobacteriaceae species, which are rarely isolated in healthy children, have been reported in children with constipation.

• #37 Functional constipation in children: challenges and solutions | PHMT

  https://www.dovepress.com/functional-constipation-in-children-challenges-and-solutions-peer-reviewed-fulltext-article-PHMT

  Many patients with FC have a positive family history of FC, suggesting that genetic factors may play a role, although mutations have not been discovered. FC is associated with neurodevelopmental disorders such as autism spectrum disorders (ASDs). This physio-pathological pathway remains unclear but is suggested to be due to a lack of adequate behavior in response to a sense of defecation urge. […] There is an association between parental child-rearing attitudes and FC. Higher and lower scores on the autonomy attitude scale are associated with decreased defecation frequency and increased fecal incontinence; this association was more clearly found in children over 6 years of age. […] Stressful life events, such as (sexual) abuse, may also play a role in the development of FC.

• #38 The ten “hard” questions in pediatric functional constipation | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01623-y

  The etiology of FC remains unknown, but it seems to be multifactorial: genetic factors, lifestyle factors (e.g., diet and physical activity), and psychological disorders are likely to be involved. In particular, a crucial role seems to be played by the alteration of the rectal and pelvic floor functions through the brain-gut axis. […] Changes in routine or diet, weaning, stressful events, entering kindergarten, intercurrent illnesses and even school can contribute to the problem. […] It is commonly believed that a low-fiber diet contributes to constipation. Actually, the literature on this issue is still conflicting. […] Recent evidence demonstrates that FC may be the result of alterations of intestinal microbiota and microbiota-gut-brain axis. […] The composition of gut microbiota in infants depends on delivery mode and cesarean delivery was associated with high risk of FC.

• #39 Pathophysiology of functional constipation in children – DNB Pediatrics

  https://www.dnbpediatrics.com/2022/10/functional-constipation.html

  These children develop a stool-withholding maneuver or retentive posture which parents mistakenly think it as an attempt to defecate. […] Eventually, liquid stool from the proximal colon may percolate around these hard stools and pass per rectum involuntarily (fecal incontinence). […] With more and more stasis, the rectum becomes dilated and redundant, and the sensitivity of the defecation reflex and the effectiveness of peristaltic contractions of rectal muscles decrease. […] In some children, Functional constipation can result from low number of interstitial cells of Cajal without any other significant pathological organic findings. […] Many children with functional constipation have a positive family history. In this subgroup genetic factors may play a role. Neurodevelopmental disorders such as autism spectrum disorders (ASDs) can be associated with functional constipation resulting from lack of adequate behavioral response to a defecation sensation.

• #40 Constipation in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children

  Stress, desire for control, and sexual abuse are also some of the functional causes of stool retention and subsequent constipation. […] Evaluation should focus on differentiating functional constipation from constipation with an organic cause. […] A primary finding that suggests an organic cause in neonates is constipation from birth; those who have had a normal bowel movement are unlikely to have a significant structural disorder. […] In older children, clues to an organic cause include constitutional symptoms (particularly weight loss, fever, or vomiting), poor growth (decreasing percentile on growth charts), an overall ill appearance, and any focal abnormalities detected during examination. […] A well-appearing child who has no other symptoms besides constipation, who is not taking any constipating medications, and who has a normal examination likely has a functional disorder. […] Specific organic causes of constipation should be treated. […] Functional constipation is ideally initially treated with dietary changes and behavior modification. […] For maintenance of healthy bowels, some children may require over-the-counter dietary fiber supplements.

• #41

  https://link.springer.com/article/10.1007/s40272-023-00563-0

  Functional constipation is a common problem in childhood worldwide and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. […] The pathophysiology of FC is considered to be multifactorial. In young children, withholding behavior is one of the major contributing factors for developing constipation. […] Withholding stools and postponing defecation results in prolonged periods of absorption of water in the colon and rectum. This leads to dry and hard stools that are more difficult to pass and cause pain during defecation, which further stimulates withholding behavior. […] Psychological factors and behavioral disorders, such as autism spectrum disorders and attention-deficit/hyperactivity disorder, may also play a role in the pathophysiology of FC.

• #42 Frontiers | Probiotics for functional constipation in children: an overview of overlapping systematic reviews

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1323521/full

  Functional constipation (FC) is a highly prevalent disorder in children with a cumulative global prevalence of 9.5% (Koppen I. et al., 2018). […] The pathophysiologic mechanisms of FC in children are generally recognized as complex and multifactorial, including disturbed gut microbiota, anorectal dysfunctions, stool withholding behavior, psychological issues, genetic predisposition, and diet (Levy et al., 2017). Stool withholding behavior is thought to be the main pathophysiological mechanism of FC in children. […] The role of the gut microbiome in the pathophysiology of FC is increasingly being emphasized. It has been shown that there are significant differences in the gut microbiota between healthy individuals and children with FC (Shin et al., 2019). […] Therefore, targeting the gut microbiota for the treatment of FC has become an area of great interest to researchers. Probiotic have been recognized as a promising therapy for the treatment of FC in children.

• #43 The oral cavity and intestinal microbiome in children with functional constipation | Scientific Reports

  https://www.nature.com/articles/s41598-024-58642-2

  Constipation is a widespread problem in paediatric practice, affecting almost 30% of children. One of the key causal factors of constipation may be disturbances in the homeostasis of the gastrointestinal microbiome. […] One of the key causal factors of constipation is believed to be disturbances in the homeostasis of the gastrointestinal microbiome. […] In as much as 90-95% of cases, constipation has a functional basis deriving from a combination of dysfunction in the large intestine, and abnormalities in the pelvic floor and anal sphincter. […] However, the causal relationship between such changes in the microbiome and impaired intestinal motility remains poorly understood. […] The gut microbiome is known to influence the intestinal peristalsis through various mechanisms, such as changes in intestinal pH, butyric acid concentration, metabolism of bile acids, neuroendocrine factor production, methane production in the intestinal lumen, and the modulation of gene expression.

• #44 The oral cavity and intestinal microbiome in children with functional constipation | Scientific Reports

  https://www.nature.com/articles/s41598-024-58642-2

  Constipation is a widespread problem in paediatric practice, affecting almost 30% of children. One of the key causal factors of constipation may be disturbances in the homeostasis of the gastrointestinal microbiome. […] One of the key causal factors of constipation is believed to be disturbances in the homeostasis of the gastrointestinal microbiome. […] In as much as 90-95% of cases, constipation has a functional basis deriving from a combination of dysfunction in the large intestine, and abnormalities in the pelvic floor and anal sphincter. […] However, the causal relationship between such changes in the microbiome and impaired intestinal motility remains poorly understood. […] The gut microbiome is known to influence the intestinal peristalsis through various mechanisms, such as changes in intestinal pH, butyric acid concentration, metabolism of bile acids, neuroendocrine factor production, methane production in the intestinal lumen, and the modulation of gene expression.

• #45 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2014.17.4.203

  Higher dietary fiber intake (fruits, legumes, and vegetables) is associated with a lower incidence of constipation in some studies. […] However, the water-soluble fiber (psyllium and glucomannan) results are conflicting. […] Against common sense that drinking water is helpful for constipation, many well-known studies, including the 2014 ESPGHAN and ESPGHAN paper, insist that no evidence supports the use of extra fluid intake to treat functional constipation. […] The proposed probiotic mechanism for constipation involves 1) Bifidobacteria and lactobacilli produce lactic acid, acetic acid, and other acids, which lower pH in the colon and enhance peristalsis. […] Dysbiosis of intestinal flora, high frequencies of Clostridium and Enterobacteriaceae species, which are rarely isolated in healthy children, have been reported in children with constipation.

• #46 The oral cavity and intestinal microbiome in children with functional constipation | Scientific Reports

  https://www.nature.com/articles/s41598-024-58642-2

  Despite the current standards of disease management, most methods used so far in the treatment of constipation are not very effective. […] In view of the documented relationship between functional constipation and dysbiosis of the gastrointestinal microbiome, it has been proposed that influencing the microbiome through the use of probiotics and synbiotics may relieve the symptoms. […] The disturbances in microbiome homeostasis may constitute a modifiable factor influencing the development and course of constipation in children. […] Our findings reveal significant differences between the saliva and stool microbiomes, and hence probably also between those of the mouth and the large intestine, both in children with constipation and those without. […] Constipation is known to be associated with stool retention in the intestine, which causes changes in the physicochemical conditions of the gut, e.g. in the pH range; this promotes the multiplication and development of different bacteria compared to physiological conditions, and consequently, higher concentrations of their metabolites.

• #47 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2014.17.4.203

  Higher dietary fiber intake (fruits, legumes, and vegetables) is associated with a lower incidence of constipation in some studies. […] However, the water-soluble fiber (psyllium and glucomannan) results are conflicting. […] Against common sense that drinking water is helpful for constipation, many well-known studies, including the 2014 ESPGHAN and ESPGHAN paper, insist that no evidence supports the use of extra fluid intake to treat functional constipation. […] The proposed probiotic mechanism for constipation involves 1) Bifidobacteria and lactobacilli produce lactic acid, acetic acid, and other acids, which lower pH in the colon and enhance peristalsis. […] Dysbiosis of intestinal flora, high frequencies of Clostridium and Enterobacteriaceae species, which are rarely isolated in healthy children, have been reported in children with constipation.

• #48 Functional constipation in children: What physicians should know

  https://www.wjgnet.com/1007-9327/full/v29/i8/1261.htm

  Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. […] Its pathophysiological mechanisms are thought to be multifactorial and complicated, resulting in difficult management. […] The etiology of constipation can be classified into functional and organic causes, which account for 90% and 10% of the cases, respectively. […] Regarding FC, the pathophysiological mechanism might be multifactorial, including stool withholding behavior, anorectal dysfunctions, diet, physical activity, genetic predisposition, and psychological issues. […] Stool withholding behavior is the main pathophysiological mechanism especially in toddlers and young children.

• #49 Constipation in children – Wikipedia

  https://en.wikipedia.org/wiki/Constipation_in_children

  Constipation in children refers to the medical condition of constipation in children. It is a functional gastrointestinal disorder. […] The median onset of functional constipation in children is at 2.3 years old, with girls and boys being similarly affected. […] Constipation in children may present as encopresis, or the inappropriate passage of stool (usually involuntarily) in inappropriate places. […] Stool can build up in the rectum, leading to rectal dilation and decreased gastric emptying. This can present as nausea, vomiting, abdominal distention, loss of appetite and pain. […] Chronic constipation in children has been associated with urinary stasis and urinary tract infections. […] 95% of cases of constipation in children are thought to be functional constipation (without a structural or biochemical cause).

• #50 Constipation in children – Wikipedia

  https://en.wikipedia.org/wiki/Constipation_in_children

  A number of diseases present at birth can result in constipation. They are as a group uncommon with Hirschsprung’s disease (HD) being the most common. […] Concern for HD should be raised in a child who has not passed stool during the first 48 hours of life. […] Milder forms of HD, in which only a small portion of the colon is affected, can present later in childhood as constipation, abdominal pain, and bloating. […] There are also congenital structural anomalies that can lead to constipation, including anterior displacement of the anus, imperforate anus, strictures, and small left colon syndrome. […] Some symptoms that may indicate an underlying disease include bowel movements that contain blood, severe abdominal bloating, and failure to thrive. […] The Rome process suggests a diagnosis of constipation in children fewer than 4 years old when the child has 2 or more of the following complaints for at least 1 month.

• #51 Constipation in children – Wikipedia

  https://en.wikipedia.org/wiki/Constipation_in_children

  A number of diseases present at birth can result in constipation. They are as a group uncommon with Hirschsprung’s disease (HD) being the most common. […] Concern for HD should be raised in a child who has not passed stool during the first 48 hours of life. […] Milder forms of HD, in which only a small portion of the colon is affected, can present later in childhood as constipation, abdominal pain, and bloating. […] There are also congenital structural anomalies that can lead to constipation, including anterior displacement of the anus, imperforate anus, strictures, and small left colon syndrome. […] Some symptoms that may indicate an underlying disease include bowel movements that contain blood, severe abdominal bloating, and failure to thrive. […] The Rome process suggests a diagnosis of constipation in children fewer than 4 years old when the child has 2 or more of the following complaints for at least 1 month.

• #52 Assessing indicators and clinical differences between functional and organic childhood constipation: a retrospective study in pediatric gastroenterology clinics

  https://www.e-cep.org/journal/view.php?number=20125555624

  The organic causes of constipation are shown in Table 2. The overall organic causes were in order of neurological causes, allergies, endocrine, gastrointestinal, and genetic diseases. However, CMPA was specifically the commonest (n=35, 5.7%), followed by cerebral palsy (n=27, 4.4%) and hypothyroidism (n=15, 2.4%). […] In this study, the most common organic cause was CMPA (5.7%). Similarly, Altamimi reported CMPA as one of the leading causes for OC. CMPA is the most common cause of constipation in the first 3 years of life. The presence of allergic inflammation of the rectal mucosa can lead to increased resting anal sphincter pressure and an abnormal relaxation of the anal canal causing chronic constipation, that disappear after elimination of cows milk protein from the diet.

• #53 Constipation in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children

  Constipation in children is divided into 2 main types: […] Organic causes of constipation involve specific structural, neurologic, toxic/metabolic, or intestinal disorders. They are rare but important to recognize. […] Functional constipation is difficulty passing stools for reasons other than organic causes. […] Children are prone to develop functional constipation during 3 periods: After the introduction of cereals and solid food, During toilet training, During the start of school. […] To avoid having a bowel movement, children may tighten the external sphincter muscles, pushing the stool higher in the rectal vault. If this behavior is repeated, the rectum stretches to accommodate the retained stool. The urge to defecate is then decreased, and the stool becomes harder, leading to a vicious circle of painful defecation and worsened constipation.

• #54 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Constipation in children is usually functional constipation without an organic cause. Organic causes of constipation in children, which include Hirschsprung disease, cystic fibrosis, and spinal cord abnormalities, commonly present with red flag signs and symptoms. […] Constipation leads to painful bowel movements, which can cause the child to withhold stool. Withholding stool increases colonic water absorption, making the stool firmer and more difficult to pass. The child contracts the anal sphincter or gluteal muscles by stiffening the body to avoid another painful bowel movement. […] Over time, fecal retention stretches the rectum, which decreases the urge to defecate. The accumulation of stool in the rectum causes a decrease in gastric emptying, resulting in abdominal distention, abdominal pain, nausea, and loss of appetite.

• #55 Assessing indicators and clinical differences between functional and organic childhood constipation: a retrospective study in pediatric gastroenterology clinics

  https://www.e-cep.org/journal/view.php?number=20125555624

  The organic causes of constipation are shown in Table 2. The overall organic causes were in order of neurological causes, allergies, endocrine, gastrointestinal, and genetic diseases. However, CMPA was specifically the commonest (n=35, 5.7%), followed by cerebral palsy (n=27, 4.4%) and hypothyroidism (n=15, 2.4%). […] In this study, the most common organic cause was CMPA (5.7%). Similarly, Altamimi reported CMPA as one of the leading causes for OC. CMPA is the most common cause of constipation in the first 3 years of life. The presence of allergic inflammation of the rectal mucosa can lead to increased resting anal sphincter pressure and an abnormal relaxation of the anal canal causing chronic constipation, that disappear after elimination of cows milk protein from the diet.

• #56 Constipation in children, paediatrics (540) | Right Decisions

  https://rightdecisions.scot.nhs.uk/shared-content/ggc-clinical-guidelines/paediatrics/emergency-medicine/constipation-in-children-paediatrics-540/

  Constipation is a common complaint in infants and children. The aetiology of constipation is multi-factorial and seldom caused by structural, endocrine or metabolic disease. […] In many children, constipation is triggered by experience of painful bowel movements, caused by factors such as toilet training, change in routine or diet, stressful events, intercurrent illness or delaying defaecation. […] Most children have no underlying organic cause for constipation i.e. they have functional constipation. Organic causes are uncommon and found more frequently in infants 1 yr. […] Organic causes: Hirschsprungs Disease, Cystic Fibrosis, Metabolic conditions eg hypothyroidism, Neurological disability eg cerebral palsy, Anorectal anomalies. […] Non-Organic causes/Risk factors: Many drugs – Antihistamines/anticonvulsants/iron supplements and many more, Intolerance to cows milk, Inadequate fluid intake, Poor diet including excess milk, Low fiber diet, Lack of exercise, Obesity.

• #57 Constipation in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children

  Stress, desire for control, and sexual abuse are also some of the functional causes of stool retention and subsequent constipation. […] Evaluation should focus on differentiating functional constipation from constipation with an organic cause. […] A primary finding that suggests an organic cause in neonates is constipation from birth; those who have had a normal bowel movement are unlikely to have a significant structural disorder. […] In older children, clues to an organic cause include constitutional symptoms (particularly weight loss, fever, or vomiting), poor growth (decreasing percentile on growth charts), an overall ill appearance, and any focal abnormalities detected during examination. […] A well-appearing child who has no other symptoms besides constipation, who is not taking any constipating medications, and who has a normal examination likely has a functional disorder. […] Specific organic causes of constipation should be treated. […] Functional constipation is ideally initially treated with dietary changes and behavior modification. […] For maintenance of healthy bowels, some children may require over-the-counter dietary fiber supplements.

• #58 Assessing indicators and clinical differences between functional and organic childhood constipation: a retrospective study in pediatric gastroenterology clinics

  https://www.e-cep.org/journal/view.php?number=20125555624

  The organic causes of constipation are shown in Table 2. The overall organic causes were in order of neurological causes, allergies, endocrine, gastrointestinal, and genetic diseases. However, CMPA was specifically the commonest (n=35, 5.7%), followed by cerebral palsy (n=27, 4.4%) and hypothyroidism (n=15, 2.4%). […] In this study, the most common organic cause was CMPA (5.7%). Similarly, Altamimi reported CMPA as one of the leading causes for OC. CMPA is the most common cause of constipation in the first 3 years of life. The presence of allergic inflammation of the rectal mucosa can lead to increased resting anal sphincter pressure and an abnormal relaxation of the anal canal causing chronic constipation, that disappear after elimination of cows milk protein from the diet.

• #59 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2014.17.4.203

  Breast-milk-fed infants are less frequently constipated than those who are formula fed. […] A food allergy to cow milk protein can also cause constipation. […] Colon peristalsis in infants with constipation is abolished after ingesting cow’s milk but recovers after stopping cow’s milk. […] Fruits thought to be useful for treating constipation are pear, grape, plump, and apple with peel, which are rich in fiber. […] Green kiwifruit significantly increases defecation frequency, stool volume, softness of bowel motion, and ease of defecation in adult clinical studies. […] A prune is a dried plum, and these fruits are beneficial for constipation. […] Several types of persimmon are available. […] Tannin acid reduced small intestinal secretions and inhibits peristalsis. […] We recommend not feeding banana to a constipated child, as many other good sources of fiber are available. […] Constipation cannot be managed using medication alone. Better short- and long-term outcomes are achieved with lifestyle changes, including a proper diet.

• #60 Assessing indicators and clinical differences between functional and organic childhood constipation: a retrospective study in pediatric gastroenterology clinics

  https://www.e-cep.org/journal/view.php?number=20125555624

  The organic causes of constipation are shown in Table 2. The overall organic causes were in order of neurological causes, allergies, endocrine, gastrointestinal, and genetic diseases. However, CMPA was specifically the commonest (n=35, 5.7%), followed by cerebral palsy (n=27, 4.4%) and hypothyroidism (n=15, 2.4%). […] In this study, the most common organic cause was CMPA (5.7%). Similarly, Altamimi reported CMPA as one of the leading causes for OC. CMPA is the most common cause of constipation in the first 3 years of life. The presence of allergic inflammation of the rectal mucosa can lead to increased resting anal sphincter pressure and an abnormal relaxation of the anal canal causing chronic constipation, that disappear after elimination of cows milk protein from the diet.

• #61 Chronic Constipation? Hold the Milk!logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/pa201007210000001/2010/07/21/chronic-constipation-hold-milk

  One third of children with chronic constipation improved after cow’s milk was removed from their diet. Cow’s milk has been linked with chronic constipation in children, and an immune response to cow’s-milk protein has been proposed as a possible mechanism. […] Removal of cow’s milk resolved constipation in a substantial subset of children, and, although this was not a randomized blinded trial, the finding that reintroduction of cow’s milk led to relapse is compelling. The results do not support an obvious immune mechanism for chronic constipation related to cow’s-milk protein, but the authors note that the timing of resolution and relapse might suggest a delayed allergic response.

• #62 Paediatric constipation: An approach and evidence-based treatment regimen

  https://www1.racgp.org.au/ajgp/2018/may/paediatric-constipation

  The presence of abdominal pain, distension, behaviour change and anorexia in these children may indicate a need for disimpaction. […] Organic causes of incontinence include spinal cord or sphincter anomalies. […] Constipation can be associated with food allergy, particularly to cows milk. […] Allergy testing is not recommended to diagnose suspected cows milk allergy in children with constipation, as it is usually not IgE mediated. […] A one-month trial of avoiding cows milk and soy protein may be indicated in children with intractable constipation. […] Normal fibre intake, fluid intake and exercise are recommended for children with constipation. […] For children who are not yet toilet-trained for stool, and who feel more secure defaecating in a diaper, this should be encouraged while the stool is softened with laxatives and the child regains confidence.

• #63

  https://www.tropicalgastro.com/articles/28/3/Review-of-pathogenesis-and-management-of-constipation.html

  Constipation is likely to be common in the Indian population. […] In the last decade, significant advances have been made in understanding constipation and in particular its pathogenesis. […] PATHOGENESIS Constipation can result from several factors, some of which are related to the persons life style such as a diet poor in fibre, insufficient fluid intake, irregular and inadequate time in the toilet, lack of exercise, prolonged bed rest and chronic consumption of drugs that can cause constipation. […] Pathophysiologically, constipation may result from slow colonic transit, faecal evacuation disorders (e.g. anismus or puborectal dyssynergia, rectocele and perineal descent syndrome) and a combination of slow colonic transit and faecal evacuation disorder. […] Some of the recent reports suggested that functional constipation might have some subtle organic basis, which could alter colonic motility or rectoanal co-ordination. […] Normal defecation involves the coordinated relaxation of the internal anal sphincter, puborectalis and external anal sphincter muscles, together with increased intra-abdominal pressure and colonic motor activity that propels stools towards the rectum.

• #64

  https://www.indianpediatrics.net/apr2016/apr-319-327.htm

  In normal defecation there is synchronized relaxation of puborectalis muscle and external anal sphincter along with generation of propulsive force through contraction of colon and increased in intra-abdominal pressure, which propels stools out of rectum. […] In dyssynergic defecation there is paradoxical contraction or failure of relaxation of external anal sphincter and puborectalis muscle with or without increased rectal pressure. […] The treatment options for internal anal sphincter achalasia are posterior anal sphincter myectomy and intrasphincteric botulinum toxin injection. […] Constipation is quite common in Asia, and most often of functional origin. […] Disimpaction with oral polyethylene glycol is the main step in the management and skipping this step leads to refractoriness of constipation.

• #65

  https://www.tropicalgastro.com/articles/28/3/Review-of-pathogenesis-and-management-of-constipation.html

  Constipation is likely to be common in the Indian population. […] In the last decade, significant advances have been made in understanding constipation and in particular its pathogenesis. […] PATHOGENESIS Constipation can result from several factors, some of which are related to the persons life style such as a diet poor in fibre, insufficient fluid intake, irregular and inadequate time in the toilet, lack of exercise, prolonged bed rest and chronic consumption of drugs that can cause constipation. […] Pathophysiologically, constipation may result from slow colonic transit, faecal evacuation disorders (e.g. anismus or puborectal dyssynergia, rectocele and perineal descent syndrome) and a combination of slow colonic transit and faecal evacuation disorder. […] Some of the recent reports suggested that functional constipation might have some subtle organic basis, which could alter colonic motility or rectoanal co-ordination. […] Normal defecation involves the coordinated relaxation of the internal anal sphincter, puborectalis and external anal sphincter muscles, together with increased intra-abdominal pressure and colonic motor activity that propels stools towards the rectum.

• #66

  https://www.indianpediatrics.net/apr2016/apr-319-327.htm

  In normal defecation there is synchronized relaxation of puborectalis muscle and external anal sphincter along with generation of propulsive force through contraction of colon and increased in intra-abdominal pressure, which propels stools out of rectum. […] In dyssynergic defecation there is paradoxical contraction or failure of relaxation of external anal sphincter and puborectalis muscle with or without increased rectal pressure. […] The treatment options for internal anal sphincter achalasia are posterior anal sphincter myectomy and intrasphincteric botulinum toxin injection. […] Constipation is quite common in Asia, and most often of functional origin. […] Disimpaction with oral polyethylene glycol is the main step in the management and skipping this step leads to refractoriness of constipation.

• #67 Constipation pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Constipation_pathophysiology

  Primary constipation is caused by anorectal and colonic problems, while secondary constipation is caused by organic and metabolic diseases or medications. […] Diseases that disturb the nervous system may lead to constipation, such as diabetes mellitus, autonomic neuropathy, Chagas’ disease, and Hirschsprung’s disease. […] HAPCs are usually decreased in constipation and maybe the main pathophysiology of constipation. […] On molecular basis, the primary movements of the gut (peristalsis) are regulated through serotonin (5-hydroxytriptamine [5HT]). […] Primary constipation is considered when the secondary causes of constipation are ruled out. […] The slow-transit constipation is due to decreased number of interstitial cells of Cajal (ICC) and alteration of myenteric plexus neurons which secretes substance P. […] The primary defect in dyssynergia is lack of coordination among abdominal, rectoanal, and pelvic floor muscles contractions during defecation process. […] Most of medications can lead to constipation as a side effect.

• #68

  https://www.indianpediatrics.net/apr2016/apr-319-327.htm

  In normal defecation there is synchronized relaxation of puborectalis muscle and external anal sphincter along with generation of propulsive force through contraction of colon and increased in intra-abdominal pressure, which propels stools out of rectum. […] In dyssynergic defecation there is paradoxical contraction or failure of relaxation of external anal sphincter and puborectalis muscle with or without increased rectal pressure. […] The treatment options for internal anal sphincter achalasia are posterior anal sphincter myectomy and intrasphincteric botulinum toxin injection. […] Constipation is quite common in Asia, and most often of functional origin. […] Disimpaction with oral polyethylene glycol is the main step in the management and skipping this step leads to refractoriness of constipation.

• #69 Toddler Constipation: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17785-constipation-in-children

  Constipation in toddlers usually doesnt last long. Its typically not something to worry about. Only rarely, is it a symptom of an underlying health condition. […] Toddlers often become constipated because they hold in their stool. As a result, their colon absorbs too much fluid and their poop becomes dry and hard to pass. […] Other causes of constipation in toddlers include: A low-fiber diet. Not getting enough fluids. Certain medications. Disorders such as Hirschsprung disease or celiac disease. Birth defects such as spina bifida. Health conditions that affect their metabolism such as diabetes. Medical conditions that affect their hormones such as hypothyroidism. Illnesses that cause a loss of appetite. Stress caused by school or by changes in routine, weather or travel. […] Constipation in toddlers usually doesnt last for long. But avoiding pooping can lead to: Fecal impaction: Hard stool packs your childs intestine and rectum too tightly for them to push out. Encopresis: The inability to regulate the passage of stool, which leads to accidents. Anal fissures: Small tears in your childs anus that cause bleeding, itching or pain. Rectal prolapse: Your childs rectum sticks out of their anus. Hemorrhoids: Swollen veins inside of your childs rectum or outside of their anus.

• #70 Constipation in Children: Causes, Signs & Treatment | CHOC

  https://choc.org/programs-services/gastroenterology/constipation/

  Constipation is typically caused by an external factor or change in diet/lifestyle, but more severe or chronic cases of constipation can be due to an underlying condition. Some of the most common causes of constipation in children include: Medications, Lack of exercise, Not enough liquids, Not enough fiber in the diet, Irritable bowel syndrome, Ignoring the urge to have a bowel movement, Changes in habits or lifestyle, Problems with intestinal function. […] Chronic constipation occurs when symptoms last for a prolonged period, typically longer than 3 weeks, despite efforts to treat the condition. […] Treatment of children with chronic constipation is necessary to reduce their risk of developing other complications such as: Hemorrhoids, which occur by straining to have a bowel movement, Anal fissures (tears in the skin around the anus), which occur when hard stool stretches the sphincter muscle. This can result in rectal bleeding.

• #71 Constipation and children | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children

  The causes of a child’s constipation may not always be clear, but may include: If a child is drinking too much milk and not getting enough solids, the lack of fibre can cause constipation. […] A tear in the skin next to the anus (called an anal fissure) may be caused by doing a hard poo. This will make the child try to hold on for longer because it may hurt to go to the toilet. […] Some children ignore the urge to go to the toilet because they are too busy playing. […] Some children hold back when they are being toilet trained. […] Some children don’t want to use school or preschool toilets for various reasons, such as lack of privacy or a smelly toilet. […] The child may not be getting enough exercise. […] Some of the signs of constipation in children include: saying that it hurts when doing a poo.

• #72 (PDF) Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.academia.edu/29279753/Constipation_in_Children_Novel_Insight_Into_Epidemiology_Pathophysiology_and_Management

  Constipation is a common problem in childhood, with a children prevalence varying between 0.7% and 29.6%. […] Constipation is encountered in all pediatric age groups, with variably severity and duration, from mild and short to severe and chronic forms, with faecal impact and encopresis. […] Despite the use of laxatives, stool softeners, behavioral modification, and diet management, a small percentage of that group develops debilitating symptoms that can be associated with severe intractable constipation. […] A substantial portion of children remained symptomatic after 2-3 years of follow-up indicating a need for regular evaluation of children with FC. […] Although many children with FC respond to conventional treatment methods, it is especially important to gain a more thorough understanding of treatment options for children with refractory constipation.

• #73 Paediatric constipation: An approach and evidence-based treatment regimen

  https://www1.racgp.org.au/ajgp/2018/may/paediatric-constipation

  Goals of drug therapy are to soften stools to eliminate the child’s fear of painful defaecation. […] Insufficient treatment can lead to long-term bowel damage from impacted stool. […] Oral polyethylene glycol (PEG) 3350 with or without electrolytes is the most effective first-line treatment for disimpaction in the outpatient setting. […] Treatment of constipation is not effective if faecal impaction is not treated. […] In the case of chronic constipation, families should continue with PEG and aim for extra soft stools, type 5 or 6 on the Bristol stool scale. […] Children will often need three months of treatment if they have had a previously normal bowel habit, a short duration of symptoms (less than three months) and are toilet trained. […] Constipation should be resolved for at least one month before treatment is ceased.

• #74 The ten “hard” questions in pediatric functional constipation | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01623-y

  The prognosis of FC in children was evaluated in a systematic review, including 14 heterogeneous prospective follow-up studies with a total of 1752 children. This review reported that half of the children treated for FC were recovered and taken off laxatives after 6-12 months of follow-up. Approximately an additional 10% were symptom free while taking laxatives. After a follow-up of 12 years and 5-10 years, the recovery rate was 58% and 56%, respectively.

• #75 (PDF) Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.academia.edu/29279753/Constipation_in_Children_Novel_Insight_Into_Epidemiology_Pathophysiology_and_Management

  Constipation is a common problem in childhood, with a children prevalence varying between 0.7% and 29.6%. […] Constipation is encountered in all pediatric age groups, with variably severity and duration, from mild and short to severe and chronic forms, with faecal impact and encopresis. […] Despite the use of laxatives, stool softeners, behavioral modification, and diet management, a small percentage of that group develops debilitating symptoms that can be associated with severe intractable constipation. […] A substantial portion of children remained symptomatic after 2-3 years of follow-up indicating a need for regular evaluation of children with FC. […] Although many children with FC respond to conventional treatment methods, it is especially important to gain a more thorough understanding of treatment options for children with refractory constipation.

• #76

  https://link.springer.com/article/10.1007/s40272-023-00563-0

  Other factors that have been suggested to play a role in the development of FC are socioeconomic status, specific parental child-rearing attitudes, genetics, lifestyle, diet, the gut microbiome, and colonic dysmotility. […] The first step in treating FC involves education, demystification, lifestyle advice, and toilet training (when developmental age is at least 4 years). […] The pathophysiology of FC is considered to be multifactorial, and withholding behavior plays a major role.

• #77 The ten “hard” questions in pediatric functional constipation | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01623-y

  Functional constipation is a common problem in childhood and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. No organic cause of the constipation can be found in approximately 95% of children, defining the so-called chronic functional constipation. Its prevalence has been reported to range from 0.7 to 29.6%, with a median of 12%. The diagnosis of functional constipation is exclusively clinical based on the pediatric diagnostic Rome criteria for functional gastrointestinal disorders and does not routinely require laboratory and/or radiological investigations. […] Pathophysiology of FC is multifactorial but the stool withholding behavior seems to be the main etiological agent. […] The main pathophysiological mechanism, especially in toddlers and young children, is the stool retention behavior. Retention of stool in the rectum causes water to be absorbed by the rectal mucosa resulting in increasingly lumpy and hard stools. This process leads to a vicious cycle of difficult defecation. Furthermore, if large stools are retained in the rectum, the rectal wall can become more and more distended resulting in fecal overflow incontinence, loss of rectal sensation, and loss of the normal urge to defecate.

• #78

  https://www.tropicalgastro.com/articles/28/3/Review-of-pathogenesis-and-management-of-constipation.html

  Constipation is likely to be common in the Indian population. […] In the last decade, significant advances have been made in understanding constipation and in particular its pathogenesis. […] PATHOGENESIS Constipation can result from several factors, some of which are related to the persons life style such as a diet poor in fibre, insufficient fluid intake, irregular and inadequate time in the toilet, lack of exercise, prolonged bed rest and chronic consumption of drugs that can cause constipation. […] Pathophysiologically, constipation may result from slow colonic transit, faecal evacuation disorders (e.g. anismus or puborectal dyssynergia, rectocele and perineal descent syndrome) and a combination of slow colonic transit and faecal evacuation disorder. […] Some of the recent reports suggested that functional constipation might have some subtle organic basis, which could alter colonic motility or rectoanal co-ordination. […] Normal defecation involves the coordinated relaxation of the internal anal sphincter, puborectalis and external anal sphincter muscles, together with increased intra-abdominal pressure and colonic motor activity that propels stools towards the rectum.

• #79 Pathogenesis of functional constipation | drlevinmichael

  https://www.anorectalmalformations.com/pathogenesis-of-functional-constipa

  The most recognized pathogenesis of the FC is a vicious cycle that begins with painful defecation and leads to stool-withholding behavior as a result. […] The disturbance functions of the pelvic floor muscle […] The initial stage. The childhood constipation results from intentional withholding of stool following a painful experience with defecation. […] Further development of the pathological process is characterized by a more pronounced expansion of the rectum. […] Compression and tensile other pelvic floor muscles leads to the failure of the LAM, which during defecation do not disclose the anal canal properly, which increases the frictional resistance and enhances the obstructive syndrome. […] Chronic stagnation of feces causes inflammation of the colon. […] Based on the results of examination of patients in third group and analysis of the literature, we assumed that the stagnation of feces cause in some patients with FC the inflammation with increased bowel tone.

• #80 Constipation in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children

  Stress, desire for control, and sexual abuse are also some of the functional causes of stool retention and subsequent constipation. […] Evaluation should focus on differentiating functional constipation from constipation with an organic cause. […] A primary finding that suggests an organic cause in neonates is constipation from birth; those who have had a normal bowel movement are unlikely to have a significant structural disorder. […] In older children, clues to an organic cause include constitutional symptoms (particularly weight loss, fever, or vomiting), poor growth (decreasing percentile on growth charts), an overall ill appearance, and any focal abnormalities detected during examination. […] A well-appearing child who has no other symptoms besides constipation, who is not taking any constipating medications, and who has a normal examination likely has a functional disorder. […] Specific organic causes of constipation should be treated. […] Functional constipation is ideally initially treated with dietary changes and behavior modification. […] For maintenance of healthy bowels, some children may require over-the-counter dietary fiber supplements.

• #81 Constipation in Children: Causes, Signs & Treatment | CHOC

  https://choc.org/programs-services/gastroenterology/constipation/

  There are certain red flags or alarm symptoms that could suggest an underlying condition is responsible for a child’s constipation. Laboratory testing to screen for these conditions is only recommended in children with chronic or severe constipation in the presence of red flags or when symptoms do not improve with treatment. […] Some diseases that commonly cause constipation include celiac disease, hypothyroidism, inflammatory bowel disease, spinal cord issues, neuromuscular diseases, lead poisoning, and anal malformations.

• #82 Functional constipation in children – evaluation and management

  https://www.termedia.pl/Functional-constipation-in-children-evaluation-and-management,41,23479,1,1.html

  The evaluation process includes three classic stages: interview, physical examination, and medical tests. […] The presence of abdominal distension, tenderness, and often palpable faecal masses in the abdominal examination is another important clinical feature that should not be overlooked. […] In contrast to organic causes, functional constipation is correlated with a strong fear of rectal examination. […] The length of treatment varies, and it may take from a few months up to as long as 4 years. […] The process of management includes non-pharmacological and pharmacological interventions. […] When functional constipation is finally recognised, a specific management program must be individually adapted for each patient to enable its implementation according to the patients needs and preferences. […] The most effective and recommended method of treatment is nonpharmacological intervention, which is safe, has no side effects, and brings long-term benefits.

• #83 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2014.17.4.203

  Breast-milk-fed infants are less frequently constipated than those who are formula fed. […] A food allergy to cow milk protein can also cause constipation. […] Colon peristalsis in infants with constipation is abolished after ingesting cow’s milk but recovers after stopping cow’s milk. […] Fruits thought to be useful for treating constipation are pear, grape, plump, and apple with peel, which are rich in fiber. […] Green kiwifruit significantly increases defecation frequency, stool volume, softness of bowel motion, and ease of defecation in adult clinical studies. […] A prune is a dried plum, and these fruits are beneficial for constipation. […] Several types of persimmon are available. […] Tannin acid reduced small intestinal secretions and inhibits peristalsis. […] We recommend not feeding banana to a constipated child, as many other good sources of fiber are available. […] Constipation cannot be managed using medication alone. Better short- and long-term outcomes are achieved with lifestyle changes, including a proper diet.

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