Zaparcie – Rokowania, prognozy i postęp choroby

Zaparcie
Rokowania, prognozy i postęp choroby

Zaparcie funkcjonalne u dzieci definiuje się przez obecność co najmniej 2 z 6 kryteriów, takich jak częstotliwość wypróżnień ≤3/tydzień, twarde i duże stolce, nietrzymanie kału, celowe powstrzymywanie defekacji oraz zatrzymywanie stolca. Długoterminowa obserwacja wykazała, że około 80% pacjentów w wieku 16 lat osiąga dobre wyniki kliniczne, a po tym wieku odsetek ten stabilizuje się na poziomie 75%. Czynniki ryzyka złego rokowania obejmują starszy wiek przy wystąpieniu objawów (OR 1,15; 95% CI 1,02-1,30; P=0,04), dłuższy czas od pojawienia się objawów do pierwszej wizyty w poradni (OR 1,24; 95% CI 1,10-1,40; P=0,001) oraz niższą częstość wypróżnień na początku obserwacji (OR 0,92; 95% CI 0,84-1,00; P=0,03). Pomiar czasu pasażu jelitowego (CTT) ma istotne znaczenie prognostyczne: CTT <100 godzin koreluje z lepszym rokowaniem, natomiast CTT ≥100 godzin wskazuje na gorsze wyniki po roku obserwacji. Prawidłowy CTT ma 100% negatywną wartość predykcyjną dla prawidłowej manometrii okrężnicy, co ogranicza wskazania do tego badania u pacjentów z prawidłowym czasem pasażu.

Prognoza zaparcia (Constipation Prognosis)

Rokowanie u dzieci i młodzieży
Czynniki prognostyczne w ocenie zaparcia
Zaparcie a ryzyko sercowo-naczyniowe u osób starszych
Przebieg i powikłania przewlekłego zaparcia
Wpływ leczenia na rokowanie
Kolejne rozdziały

Prognoza zaparcia (Constipation Prognosis)

Zaparcie funkcjonalne to częsta dolegliwość wieku dziecięcego, definiowana przez obecność co najmniej 2 z 6 kryteriów: częstotliwość wypróżnień ≤3/tydzień, twarde stolce, duże rozmiary stolca, nietrzymanie kału, celowe powstrzymywanie defekacji oraz zatrzymywanie stolca.¹ Rokowanie w przypadku zaparć jest uzależnione od wielu czynników, a właściwa ocena prognostyczna pomaga w planowaniu optymalnego leczenia.

Rokowanie u dzieci i młodzieży

Długoterminowa obserwacja dzieci z zaparciem funkcjonalnym wykazała, że dobre wyniki kliniczne osiąga około 80% pacjentów w wieku 16 lat. Po tym wieku odsetek ten pozostaje stały na poziomie 75%, co oznacza, że jedna czwarta dzieci z zaparciem funkcjonalnym nadal doświadcza objawów w wieku dorosłym.²

Zidentyfikowano czynniki ryzyka złego rokowania w wieku dorosłym, które obejmują:

Starszy wiek w momencie wystąpienia objawów (iloraz szans [OR]: 1,15 [95% przedział ufności (CI): 1,02-1,30]; P = 0,04)³
Dłuższy okres między wystąpieniem objawów a pierwszą wizytą w specjalistycznej poradni (OR: 1,24 [95% CI: 1,10-1,40]; P = 0,001)⁴
Niższa częstość wypróżnień przy rozpoczęciu obserwacji (OR: 0,92 [95% CI: 0,84-1,00]; P = 0,03)⁵

Te wyniki wskazują, że skierowanie do specjalistycznej poradni powinno być rozważone na wczesnym etapie u dzieci, które nie reagują na leczenie pierwszego rzutu, co może poprawić długoterminowe rokowanie.⁶

Czynniki prognostyczne w ocenie zaparcia

W ocenie rokowniczej zaparcia istotną rolę odgrywają badania diagnostyczne, w tym pomiar czasu pasażu jelitowego (CTT – Colonic Transit Time). Badania wykazały, że obecność wpuklenia odbytnicy (rectal impaction) przy pierwszej ocenie wiąże się z lepszym rokowaniem po roku obserwacji.⁷

Wyniki CTT mają istotne znaczenie prognostyczne:

Pacjenci z CTT <100 godzin mają lepsze rokowanie po roku obserwacji⁸
CTT ≥100 godzin wiąże się z gorszym rokowaniem po roku obserwacji⁹

Ważne jest również, że prawidłowy czas pasażu jelitowego (CTT) ma 100% negatywną wartość predykcyjną dla prawidłowej manometrii okrężnicy, co sugeruje, że u pacjentów z prawidłowym czasem pasażu jelitowego manometria okrężnicy nie wnosi dodatkowej wartości diagnostycznej ani terapeutycznej.¹⁰ Oznacza to, że u pacjentów z prawidłowym wynikiem badania markerów nieprzeziernych dla promieni RTG manometria okrężnicy nie ma wartości dodanej w oparciu o wyniki badań eksploracyjnych.¹¹

Zaparcie a ryzyko sercowo-naczyniowe u osób starszych

Badania przeprowadzone na dużej kohorcie australijskich pacjentów szpitalnych w wieku ≥60 lat (n=541,172) wykazały, że zaparcie jest pozytywnie i niezależnie związane z nadciśnieniem tętniczym oraz że te dwa czynniki wchodzą w interakcję, modyfikując ryzyko zdarzeń sercowo-naczyniowych.¹²

Zaobserwowano następujące zależności:

Pacjenci z zaparciem mieli wyższe skorygowane wielowymiarowo ryzyko nadciśnienia tętniczego (OR: 1,96; 95% CI: 1,94-1,99; P<0,001)¹³
W porównaniu do pacjentów bez zaparcia i bez nadciśnienia tętniczego, wyższe skorygowane wielowymiarowo ryzyko zdarzeń sercowo-naczyniowych odnotowano u pacjentów z:
- Samym zaparciem (OR: 1,58; 95% CI: 1,55-1,61; P<0,001)¹⁴
- Samym nadciśnieniem tętniczym (OR: 6,12; 95% CI: 5,99-6,26; P<0,001)¹⁵
- Zarówno zaparciem, jak i nadciśnieniem tętniczym – ryzyko zdarzeń wydawało się być addytywne (OR: 6,53; 95% CI: 6,40-6,66; P<0,001)¹⁶

Te odkrycia sugerują, że interwencje mające na celu leczenie zaparcia mogą zmniejszyć ryzyko sercowo-naczyniowe u starszych pacjentów.¹⁷ Wśród pacjentów szpitalnych w wieku 60 lat lub starszych, zaparcie wiąże się ze zwiększonym ryzykiem nadciśnienia tętniczego, udaru mózgu, zawału mięśnia sercowego oraz wszystkich zdarzeń sercowo-naczyniowych.¹⁸

Przebieg i powikłania przewlekłego zaparcia

Przewlekłe pierwotne zaparcie zwykle ma łagodny przebieg. Jednak poza wpływem na jakość życia pacjentów, może czasami powodować różne powikłania, takie jak:¹⁹

Objawy wzdęcia i bóle brzucha
Niedrożność jelit spowodowana upakowaniem mas kałowych w jelicie (jest to sytuacja niezwykle rzadka)
Hemoroidy i powiązane objawy (krwawienie, ból)
Szczelina odbytu (bolesna rana w odbycie)
Enterocele lub rectocele (obniżenie lub wypadanie pochwy, albo przepuklina jelita lub odbytnicy do pochwy)

Szczególnie istotne jest rozpoznanie objawów alarmujących, które wymagają konsultacji lekarskiej, takich jak: nagła zmiana rytmu wypróżnień, utrata masy ciała czy krew w kale – w celu wykluczenia możliwości, że zaparcie jest wtórne lub uległo pogorszeniu z powodu innego procesu chorobowego.²⁰

Wpływ leczenia na rokowanie

Leczenie zaparcia funkcjonalnego wymaga kombinacji edukacji rodziców i pacjenta, interwencji żywieniowej, interwencji behawioralnej, farmakoterapii, ścisłej obserwacji i długoterminowej zgodności z reżimem terapeutycznym.²¹ Wieloaspektowe podejście do leczenia zaparcia przekłada się na lepsze wyniki terapeutyczne i przyczynia się do korzystniejszego rokowania długoterminowego.

Proces terapeutyczny powinien być zindywidualizowany i dostosowany do specyficznych czynników prognostycznych zidentyfikowanych u danego pacjenta. Wczesna interwencja, szczególnie u dzieci z objawami zaparcia, może znacząco poprawić długoterminowe rokowanie i zapobiec utrzymywaniu się dolegliwości w wieku dorosłym.²²

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Constipation | SpringerLink
https://link.springer.com/chapter/10.1007/978-1-60761-709-9_39
Functional constipation is common in childhood and is defined by the presence of at least 2 of 6 criteria: stool frequency 3/week, hardness, large size, fecal incontinence, volitional stool withholding, and stool retention. […] Treatment of functional constipation requires a combination of parent and patient education, nutritional intervention, behavioral intervention, pharmacotherapy, close follow-up, and long-term compliance with the treatment regimen. […] Factors determining outcome in children with chronic constipation and faecal. […] Functional constipation in children: a systemic review on prognosis and predictive factors. […] Outcome of functional constipation in childhood: a 10-year follow-up study.
#2 Long-term prognosis for childhood constipation: clinical outcomes in adulthood – PubMed
https://pubmed.ncbi.nlm.nih.gov/20530072/
Objectives: This study examines long-term prognoses for children with constipation in adulthood and identifies prognostic factors associated with clinical outcomes. […] Good clinical outcomes were achieved by 80% of patients at 16 years of age. Thereafter, this proportion remained constant at 75%. Poor clinical outcomes at adult age were associated with: older age at onset (odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.02-1.30]; P = .04), longer delay between onset and first visit to our outpatient clinic (OR: 1.24 [95% CI: 1.10-1.40]; P = .001), and lower defecation frequency at study entry (OR: 0.92 [95% CI: 0.84-1.00]; P = .03). […] One-fourth of children with functional constipation continued to experience symptoms at adult age. Certain risk factors for poor clinical outcomes in adulthood were identified. Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment.
#3 Long-term prognosis for childhood constipation: clinical outcomes in adulthood – PubMed
https://pubmed.ncbi.nlm.nih.gov/20530072/
Objectives: This study examines long-term prognoses for children with constipation in adulthood and identifies prognostic factors associated with clinical outcomes. […] Good clinical outcomes were achieved by 80% of patients at 16 years of age. Thereafter, this proportion remained constant at 75%. Poor clinical outcomes at adult age were associated with: older age at onset (odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.02-1.30]; P = .04), longer delay between onset and first visit to our outpatient clinic (OR: 1.24 [95% CI: 1.10-1.40]; P = .001), and lower defecation frequency at study entry (OR: 0.92 [95% CI: 0.84-1.00]; P = .03). […] One-fourth of children with functional constipation continued to experience symptoms at adult age. Certain risk factors for poor clinical outcomes in adulthood were identified. Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment.
#4 Long-term prognosis for childhood constipation: clinical outcomes in adulthood – PubMed
https://pubmed.ncbi.nlm.nih.gov/20530072/
Objectives: This study examines long-term prognoses for children with constipation in adulthood and identifies prognostic factors associated with clinical outcomes. […] Good clinical outcomes were achieved by 80% of patients at 16 years of age. Thereafter, this proportion remained constant at 75%. Poor clinical outcomes at adult age were associated with: older age at onset (odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.02-1.30]; P = .04), longer delay between onset and first visit to our outpatient clinic (OR: 1.24 [95% CI: 1.10-1.40]; P = .001), and lower defecation frequency at study entry (OR: 0.92 [95% CI: 0.84-1.00]; P = .03). […] One-fourth of children with functional constipation continued to experience symptoms at adult age. Certain risk factors for poor clinical outcomes in adulthood were identified. Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment.
#5 Long-term prognosis for childhood constipation: clinical outcomes in adulthood – PubMed
https://pubmed.ncbi.nlm.nih.gov/20530072/
Objectives: This study examines long-term prognoses for children with constipation in adulthood and identifies prognostic factors associated with clinical outcomes. […] Good clinical outcomes were achieved by 80% of patients at 16 years of age. Thereafter, this proportion remained constant at 75%. Poor clinical outcomes at adult age were associated with: older age at onset (odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.02-1.30]; P = .04), longer delay between onset and first visit to our outpatient clinic (OR: 1.24 [95% CI: 1.10-1.40]; P = .001), and lower defecation frequency at study entry (OR: 0.92 [95% CI: 0.84-1.00]; P = .03). […] One-fourth of children with functional constipation continued to experience symptoms at adult age. Certain risk factors for poor clinical outcomes in adulthood were identified. Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment.
#6 Long-term prognosis for childhood constipation: clinical outcomes in adulthood – PubMed
https://pubmed.ncbi.nlm.nih.gov/20530072/
Objectives: This study examines long-term prognoses for children with constipation in adulthood and identifies prognostic factors associated with clinical outcomes. […] Good clinical outcomes were achieved by 80% of patients at 16 years of age. Thereafter, this proportion remained constant at 75%. Poor clinical outcomes at adult age were associated with: older age at onset (odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.02-1.30]; P = .04), longer delay between onset and first visit to our outpatient clinic (OR: 1.24 [95% CI: 1.10-1.40]; P = .001), and lower defecation frequency at study entry (OR: 0.92 [95% CI: 0.84-1.00]; P = .03). […] One-fourth of children with functional constipation continued to experience symptoms at adult age. Certain risk factors for poor clinical outcomes in adulthood were identified. Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment.
#7 Prognosis of constipation: clinical factors and colonic transit time
https://pmc.ncbi.nlm.nih.gov/articles/PMC1720034/
Measurement of colonic transit time (CTT) is sometimes used in the evaluation of patients with chronic constipation. […] To investigate the relation between symptoms and CTT, and to assess the importance of symptoms and CTT in predicting outcome. […] Successful outcome occurred more often in those with a rectal impaction. CTT results 100 hours were not predictive of outcome. However, those with CTT 100 hours were less likely to have had a successful outcome. […] The presence of a rectal impaction at presentation is associated with a better outcome at one year. A CTT 100 hours is associated with a poor outcome at one year.
#8 Prognosis of constipation: clinical factors and colonic transit time
https://pmc.ncbi.nlm.nih.gov/articles/PMC1720034/
Measurement of colonic transit time (CTT) is sometimes used in the evaluation of patients with chronic constipation. […] To investigate the relation between symptoms and CTT, and to assess the importance of symptoms and CTT in predicting outcome. […] Successful outcome occurred more often in those with a rectal impaction. CTT results 100 hours were not predictive of outcome. However, those with CTT 100 hours were less likely to have had a successful outcome. […] The presence of a rectal impaction at presentation is associated with a better outcome at one year. A CTT 100 hours is associated with a poor outcome at one year.
#9 Prognosis of constipation: clinical factors and colonic transit time
https://pmc.ncbi.nlm.nih.gov/articles/PMC1720034/
Measurement of colonic transit time (CTT) is sometimes used in the evaluation of patients with chronic constipation. […] To investigate the relation between symptoms and CTT, and to assess the importance of symptoms and CTT in predicting outcome. […] Successful outcome occurred more often in those with a rectal impaction. CTT results 100 hours were not predictive of outcome. However, those with CTT 100 hours were less likely to have had a successful outcome. […] The presence of a rectal impaction at presentation is associated with a better outcome at one year. A CTT 100 hours is associated with a poor outcome at one year.
#10
https://link.springer.com/article/10.1007/s00384-019-03376-1
Normal colonic transit time predicts the outcome of colonic manometry in patients with chronic constipationan exploratory study […] The negative predictive value of CTT for normal CM was 100%. […] These findings point to a negative predictive value of colonic transit time for normal colonic manometry of 100%, indicating that colonic manometry does not add any value to the diagnostic or therapeutic processes for constipation in patients with normal colonic transit. […] However, for patients presenting with normal transit on a radio-opaque marker study, colonic manometry does not appear to have added value on the basis of our exploratory findings.
#11
https://link.springer.com/article/10.1007/s00384-019-03376-1
Normal colonic transit time predicts the outcome of colonic manometry in patients with chronic constipationan exploratory study […] The negative predictive value of CTT for normal CM was 100%. […] These findings point to a negative predictive value of colonic transit time for normal colonic manometry of 100%, indicating that colonic manometry does not add any value to the diagnostic or therapeutic processes for constipation in patients with normal colonic transit. […] However, for patients presenting with normal transit on a radio-opaque marker study, colonic manometry does not appear to have added value on the basis of our exploratory findings.
#12 Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients | Scientific Reports
https://www.nature.com/articles/s41598-023-38068-y
These findings suggest that interventions to address constipation may reduce cardiovascular risk in elderly patients. […] In an Australian cohort comprising 541,172 hospital patients aged 60 years, we found that constipation was positively and independently associated with hypertension, and that the two factors interacted to modify the risk of cardiovascular events. […] Patients with either constipation or hypertension alone had an increased risk of myocardial infarction, stroke and all cardiovascular events, compared to patients with neither condition. […] Patients with both constipation and hypertension had an even higher risk of cardiovascular events. […] Constipation was also associated with a higher prevalence of chronic hypertension and thus it is possible that the latter condition represents a mediator of cardiovascular events in patients with constipation. […] In conclusion, among hospital patients aged 60 years or older, constipation is linked to an increased risk for hypertension, stroke, myocardial infarction, and all cardiovascular events.
#13 Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients | Scientific Reports
https://www.nature.com/articles/s41598-023-38068-y
The association between constipation and cardiovascular risk is unclear. […] Patients with constipation had a higher multivariate-adjusted risk for hypertension (odds ratio [OR], 1.96; 95% confidence interval [CI] 1.94-1.99; P<0.001). [...] In conclusion, among hospital patients aged 60 years or older, constipation is linked to an increased risk of hypertension and cardiovascular events. [...] Compared to patients with neither constipation nor hypertension, there was a higher multivariate-adjusted risk for cardiovascular events in patients with constipation alone (OR, 1.58; 95% CI 1.55-1.61; P<0.001) or hypertension alone (OR, 6.12; 95% CI 5.99-6.26; P<0.001). [...] In patients with both constipation and hypertension, the risk for all cardiovascular events appeared to be additive (OR, 6.53; 95% CI 6.40-6.66; P<0.001).
#14 Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients | Scientific Reports
https://www.nature.com/articles/s41598-023-38068-y
The association between constipation and cardiovascular risk is unclear. […] Patients with constipation had a higher multivariate-adjusted risk for hypertension (odds ratio [OR], 1.96; 95% confidence interval [CI] 1.94-1.99; P<0.001). [...] In conclusion, among hospital patients aged 60 years or older, constipation is linked to an increased risk of hypertension and cardiovascular events. [...] Compared to patients with neither constipation nor hypertension, there was a higher multivariate-adjusted risk for cardiovascular events in patients with constipation alone (OR, 1.58; 95% CI 1.55-1.61; P<0.001) or hypertension alone (OR, 6.12; 95% CI 5.99-6.26; P<0.001). [...] In patients with both constipation and hypertension, the risk for all cardiovascular events appeared to be additive (OR, 6.53; 95% CI 6.40-6.66; P<0.001).
#15 Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients | Scientific Reports
https://www.nature.com/articles/s41598-023-38068-y
The association between constipation and cardiovascular risk is unclear. […] Patients with constipation had a higher multivariate-adjusted risk for hypertension (odds ratio [OR], 1.96; 95% confidence interval [CI] 1.94-1.99; P<0.001). [...] In conclusion, among hospital patients aged 60 years or older, constipation is linked to an increased risk of hypertension and cardiovascular events. [...] Compared to patients with neither constipation nor hypertension, there was a higher multivariate-adjusted risk for cardiovascular events in patients with constipation alone (OR, 1.58; 95% CI 1.55-1.61; P<0.001) or hypertension alone (OR, 6.12; 95% CI 5.99-6.26; P<0.001). [...] In patients with both constipation and hypertension, the risk for all cardiovascular events appeared to be additive (OR, 6.53; 95% CI 6.40-6.66; P<0.001).
#16 Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients | Scientific Reports
https://www.nature.com/articles/s41598-023-38068-y
The association between constipation and cardiovascular risk is unclear. […] Patients with constipation had a higher multivariate-adjusted risk for hypertension (odds ratio [OR], 1.96; 95% confidence interval [CI] 1.94-1.99; P<0.001). [...] In conclusion, among hospital patients aged 60 years or older, constipation is linked to an increased risk of hypertension and cardiovascular events. [...] Compared to patients with neither constipation nor hypertension, there was a higher multivariate-adjusted risk for cardiovascular events in patients with constipation alone (OR, 1.58; 95% CI 1.55-1.61; P<0.001) or hypertension alone (OR, 6.12; 95% CI 5.99-6.26; P<0.001). [...] In patients with both constipation and hypertension, the risk for all cardiovascular events appeared to be additive (OR, 6.53; 95% CI 6.40-6.66; P<0.001).
#17 Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients | Scientific Reports
https://www.nature.com/articles/s41598-023-38068-y
These findings suggest that interventions to address constipation may reduce cardiovascular risk in elderly patients. […] In an Australian cohort comprising 541,172 hospital patients aged 60 years, we found that constipation was positively and independently associated with hypertension, and that the two factors interacted to modify the risk of cardiovascular events. […] Patients with either constipation or hypertension alone had an increased risk of myocardial infarction, stroke and all cardiovascular events, compared to patients with neither condition. […] Patients with both constipation and hypertension had an even higher risk of cardiovascular events. […] Constipation was also associated with a higher prevalence of chronic hypertension and thus it is possible that the latter condition represents a mediator of cardiovascular events in patients with constipation. […] In conclusion, among hospital patients aged 60 years or older, constipation is linked to an increased risk for hypertension, stroke, myocardial infarction, and all cardiovascular events.
#18 Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients | Scientific Reports
https://www.nature.com/articles/s41598-023-38068-y
These findings suggest that interventions to address constipation may reduce cardiovascular risk in elderly patients. […] In an Australian cohort comprising 541,172 hospital patients aged 60 years, we found that constipation was positively and independently associated with hypertension, and that the two factors interacted to modify the risk of cardiovascular events. […] Patients with either constipation or hypertension alone had an increased risk of myocardial infarction, stroke and all cardiovascular events, compared to patients with neither condition. […] Patients with both constipation and hypertension had an even higher risk of cardiovascular events. […] Constipation was also associated with a higher prevalence of chronic hypertension and thus it is possible that the latter condition represents a mediator of cardiovascular events in patients with constipation. […] In conclusion, among hospital patients aged 60 years or older, constipation is linked to an increased risk for hypertension, stroke, myocardial infarction, and all cardiovascular events.
#19 Constipation prognosis | Hospital ClÃnic Barcelona
https://www.clinicbarcelona.org/en/assistance/diseases/constipation/progression-of-the-disease
Chronic primary constipation usually has a benign course. However, as well as affecting the quality of life of those who have it, at times it can cause other complications. Amongst them may be the origin of distension symptoms and abdominal pain and may even include an intestinal occlusion due to impaction of faeces in the intestine, although this situation is extremely rare. Furthermore, constipation increases the likelihood of haemorrhoids and associated symptoms (bleeding, pain), anal fissure (a painful wound in the anus), enterocele or rectocele (vaginal descent or collapse, or herniation of the bowel or rectum into the vagina). […] It is also important to know which alarm signs require consultation with a doctor (sudden change in intestinal rhythm, weight loss, blood in the faeces) to exclude the possibility that the constipation is secondary, or has worsened due to another process.
#20 Constipation prognosis | Hospital ClÃnic Barcelona
https://www.clinicbarcelona.org/en/assistance/diseases/constipation/progression-of-the-disease
Chronic primary constipation usually has a benign course. However, as well as affecting the quality of life of those who have it, at times it can cause other complications. Amongst them may be the origin of distension symptoms and abdominal pain and may even include an intestinal occlusion due to impaction of faeces in the intestine, although this situation is extremely rare. Furthermore, constipation increases the likelihood of haemorrhoids and associated symptoms (bleeding, pain), anal fissure (a painful wound in the anus), enterocele or rectocele (vaginal descent or collapse, or herniation of the bowel or rectum into the vagina). […] It is also important to know which alarm signs require consultation with a doctor (sudden change in intestinal rhythm, weight loss, blood in the faeces) to exclude the possibility that the constipation is secondary, or has worsened due to another process.
#21 Constipation | SpringerLink
https://link.springer.com/chapter/10.1007/978-1-60761-709-9_39
Functional constipation is common in childhood and is defined by the presence of at least 2 of 6 criteria: stool frequency 3/week, hardness, large size, fecal incontinence, volitional stool withholding, and stool retention. […] Treatment of functional constipation requires a combination of parent and patient education, nutritional intervention, behavioral intervention, pharmacotherapy, close follow-up, and long-term compliance with the treatment regimen. […] Factors determining outcome in children with chronic constipation and faecal. […] Functional constipation in children: a systemic review on prognosis and predictive factors. […] Outcome of functional constipation in childhood: a 10-year follow-up study.
#22 Long-term prognosis for childhood constipation: clinical outcomes in adulthood – PubMed
https://pubmed.ncbi.nlm.nih.gov/20530072/
Objectives: This study examines long-term prognoses for children with constipation in adulthood and identifies prognostic factors associated with clinical outcomes. […] Good clinical outcomes were achieved by 80% of patients at 16 years of age. Thereafter, this proportion remained constant at 75%. Poor clinical outcomes at adult age were associated with: older age at onset (odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.02-1.30]; P = .04), longer delay between onset and first visit to our outpatient clinic (OR: 1.24 [95% CI: 1.10-1.40]; P = .001), and lower defecation frequency at study entry (OR: 0.92 [95% CI: 0.84-1.00]; P = .03). […] One-fourth of children with functional constipation continued to experience symptoms at adult age. Certain risk factors for poor clinical outcomes in adulthood were identified. Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment.