Published online Feb 28, 2023. doi: 10.3748/wjg.v29.i8.1261
Peer-review started: October 28, 2022
First decision: November 14, 2022
Revised: December 5, 2022
Accepted: February 16, 2023
Article in press: February 16, 2023
Published online: February 28, 2023
Processing time: 122 Days and 20.5 Hours
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 be multifactorial and complicated, resulting in difficult management. Currently, the most effective medication, when used in parallel with toilet training, is osmotic laxatives. Children’s adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure. Recently, novel therapies with a high safety profile have been developed, such as probiotics, synbiotics, serotonin 5-hydroxytryptamine 4 receptor agonists, chloride channel activators, and herbal and transitional medicines; nonetheless, well-designed research to support the use of these therapies is needed. This review aims to focus on multiple aspects of FC in children, including global prevalence, pathogenesis, diagnostic criteria, tools, as well as conventional and novel treatment options, such as non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators. We also report that in very difficult cases, surgical intervention may be required.
Core Tip: Functional constipation (FC) is a typical symptom of functional gastrointestinal disorders in children and its prevalence is high worldwide. Since the pathophysiology of FC in children is associated with stool withholding behavior, successful toilet training in combination with osmotic laxatives is crucial for the treatment childhood FC. Additionally, promising and innovative drugs can also aid in treatment success.