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Örnek Z, Pişkin İE, Abasız S. Prevalence and associated factors of lower urinary tract dysfunction in school-aged children in Zonguldak, Turkey. Pediatr Int 2025; 67:e70046. [PMID: 40277073 DOI: 10.1111/ped.70046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 12/01/2024] [Accepted: 01/17/2025] [Indexed: 04/26/2025]
Abstract
BACKGROUND Lower urinary tract dysfunction (LUTD) is a common issue in children. Data on the prevalence of LUTD in our country are limited. We aimed to investigate the prevalence and associated factors of LUTD among children in grades 1-8 in Zonguldak, located in northwestern Turkey, using a validated voiding dysfunction scoring system. METHODS The study included students in grades 1-8 from schools in central Zonguldak during the 2021-2022 academic year. Parents of children who were included in the study were sent a questionnaire via the Internet. Demographic information, the child's medical history, details about voiding habits, and voiding dysfunction symptom score (VDSS) information were obtained. The data from 654 students whose parents completed the survey were analyzed. RESULTS The prevalence of LUTD, daytime urinary incontinence, and nocturnal enuresis were 9.6% (n = 63), 12.4% (n = 81), and 13% (n = 85), respectively. According to the survey responses, the most common symptoms were urgency (n = 253, 39%), followed by holding maneuvers (n = 140, 21.4%). There was no significant relationship between the mother's educational level and daytime urinary incontinence (p = 0.091). Daytime urinary incontinence was more common in children of fathers with lower educational levels (p = 0.021). CONCLUSIONS This study demonstrates a high prevalence of LUTD among school-aged children. Constipation, urinary tract infections, and family history should be integral parts of the initial evaluation. Identifying the prevalence of LUTD and related risk factors in children is considered the first step in reducing and managing the number of affected children in the community.
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Affiliation(s)
- Zühal Örnek
- Department of Pediatrics, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - İbrahim Etem Pişkin
- Department of Pediatrics, Pediatric Intensive Care, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Sinem Abasız
- Department of Pediatrics, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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Benzamin M, Karim ASMB, Rukunuzzaman M, Mazumder MW, Rana M, Alam R, Islam MM, Alam MS, Hossen K, Yasmin A, Fathema K, Khadga M, Aishy AS. Functional constipation in Bangladeshi school aged children: A hidden misty at community. World J Clin Pediatr 2022; 11:160-172. [PMID: 35433302 PMCID: PMC8985490 DOI: 10.5409/wjcp.v11.i2.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/02/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Constipation is a common problem in children and a frequent cause of hospital visit in both primary & specialized care, which needs proper evaluation & management. Presentation of constipation is variable among children. In Bangladesh there has been no published data regarding constipation in community among school aged children.
AIM To determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.
METHODS This descriptive cross sectional study was conducted in different schools of Dhaka division, Bangladesh. All school aged children between 5-16 years of age who attended school were included in this study. Samples were collected randomly. Proper clinical history & physical examinations (without digital rectal examination) & available investigations (if done previously) were recorded. Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation. Children with any red flag sign, known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded. Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20. For all statistical tests, P value of less than 0.05 was considered as statistically significant.
RESULTS Total study populations were 707 and male was 443 and female 264. Among them, 134 (19%) children had constipation. In constipated children, 78 children fulfilled the Rome IV criteria for functional constipation and it was 11% of total population. Mean age of children having functional constipation was 11.24 ± 3.54 years and Male female ratio was 1:1.78. Anorexia, nausea, abdominal pain, hard stool, blood with hard stool, alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group. Children of school, where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number (OR = 2.493, 95%CI: 1.214-5.120). Children who feel embarrassed to use toilet at school, had 3.6 times higher risk of constipation (OR = 3.552, 95%CI: 1.435-8.794). Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs (OR = 3.977, 95%CI: 1.884–8.397) and parents/grandparents (OR = 2.569, 95%CI: 1.172-5.629). Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake (OR = 1.972, 95%CI: 1.135-3.426). Children who passed electronic screen time of > 2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time < 2 h (OR = 2.138, 95%CI: 1.063-4.301).
CONCLUSION Constipation is not uncommon in Bangladeshi school aged children. Inadequate toilet number, family history of constipation, inadequate fluid intake, feeling embarrassed to use toilet at school, and electronic screen time for > 2 h/d were found as risk factors in the present study for functional constipation.
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Affiliation(s)
- Md Benzamin
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - ASM Bazlul Karim
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Md Rukunuzzaman
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Md Wahiduzzaman Mazumder
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Masud Rana
- Department of Outpatient, Hazi Asmot Medical Centre, Bhairab 2350, Bangladesh
| | - Rubaiyat Alam
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Mohammad Majharul Islam
- Department of Paediatric Nephrology, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Md Shafiul Alam
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Kamal Hossen
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Afsana Yasmin
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Kaniz Fathema
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Mukesh Khadga
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
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El-Shabrawi M, Hanafi HM, Abdelgawad MMAH, Hassanin F, Mahfouze AAA, Khalil AFM, Elsawey SE. High-resolution anorectal manometry in children with functional constipation: a single-centre experience before and after treatment. PRZEGLAD GASTROENTEROLOGICZNY 2018; 13:305-312. [PMID: 30581505 PMCID: PMC6300846 DOI: 10.5114/pg.2018.79810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/09/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Constipation is a common disorder among children, and most of the cases are functional in aetiology. Few studies have reported the manometric data of normal and constipated children. AIM To evaluate the manometric parameters in children with functional constipation and to assess any possible changes in these parameters after treatment. MATERIAL AND METHODS A prospective descriptive study was conducted at a single centre, enrolling 50 children diagnosed with functional constipation based on Rome IV criteria. Their age ranged from 6 to 14 years with a mean of 7.31 ±1.72 years. High-resolution manometry was performed on all children at the initial presentation and after six months of treatment. RESULTS The studied children showed markedly abnormal rectal sensation parameters (increased first sensation, first urge, intense urge, and maximum tolerable volume) during rectal balloon distension. These parameters were even higher in children with stool incontinence (p = 0.005). Manometric data after 6 months of treatment showed that the resting and squeeze pressures were increased when compared to pre-treatment recordings; however, both were statistically insignificant (p = 0.474 and p = 0.155, respectively). Abnormalities in rectal sensations and the manometric parameters reached near normal values following treatment. CONCLUSIONS Anorectal manometry is sensitive in predicting improvement in patient condition even before complete clinical cure, and it has a prognostic role in the management of childhood constipation. More research is still needed before recommending anorectal manometry as a routine diagnostic or prognostic tool in paediatric constipation management.
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Affiliation(s)
- Mortada El-Shabrawi
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hind M Hanafi
- Department of Pediatric, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Fetouh Hassanin
- Department of Clinical Pharmacy, Misr International University, Cairo, Egypt
| | - Aml A A Mahfouze
- Department of Pediatric, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed F M Khalil
- Department of Pediatric, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Saeed Elsayed Elsawey
- Department of Pediatric, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Oswari H, Alatas FS, Hegar B, Cheng W, Pramadyani A, Benninga MA, Rajindrajith S. Epidemiology of Paediatric constipation in Indonesia and its association with exposure to stressful life events. BMC Gastroenterol 2018; 18:146. [PMID: 30285647 PMCID: PMC6171310 DOI: 10.1186/s12876-018-0873-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/25/2018] [Indexed: 12/18/2022] Open
Abstract
Background We aimed to study the epidemiology and risk factors, including exposure to emotional stress, for constipation in Indonesian children and adolescents of 10–17 year age group. Methods A cross-sectional survey using a validated, self-administered questionnaire was conducted in randomly selected children and adolescents in nine state junior high schools from five districts of Jakarta. All of them were from urban areas. Constipation was defined as a diagnosis by using the Rome III criteria. Results Of 1796 children included in the analysis, 328 (18.3%; 95% CI 016–0.2) had constipation. Females and those residing in North Jakarta showed risks associated with constipation in school-age children and adolescents. Symptoms independently associated with constipation were abdominal pain (64% vs 43.3% of control) and straining (22.9% vs 6.3%). The prevalence of constipation was significantly higher in those with stressful life events such as father’s alcoholism (adjusted OR 1.91, 95% CI 1.27–2.89, P = 0.002), severe illness of a close family member (adjusted OR 1.77, 95% CI 1.12–2.80, P = 0.014), hospitalization of the child for another illness (adjusted OR 1.68, 95% CI 1.22–2.31, P < 0.001), being bullied at school (adjusted OR 1.67, 95% CI 1.01–2.76, P = 0.047) and loss of a parent’s job (adjusted OR 1.39, 95% CI 1.03–1.88, P = 0.034). Conclusions Constipation in children and adolescent is a significant health problem, affecting almost 20% of Indonesian school-age children and adolescents. Common school and home related stressful life events appear to have predisposed these children to develop constipation.
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Affiliation(s)
- Hanifah Oswari
- Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Fatima Safira Alatas
- Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Badriul Hegar
- Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - William Cheng
- Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Arnesya Pramadyani
- Department of Child Health, Gastrohepatology Division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's, Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Abstract
BACKGROUND Obesity and functional constipation seem to share a common biopsychosocial model of causation. Though chronic constipation can significantly affect the quality of life of an overweight child, this association has not been highlighted in the literature. The purpose of this study was to compare the proportion of overweight children among children with chronic constipation with a control group of children with normal bowel habits. METHODS Retrospective chart review with a control population. One hundred one consecutive children 5-18 years of age referred to the Subspecialty Clinic for functional constipation were the study group. The control group consisted of 100 consecutive children from the general pediatric practice seen for physicals and minor illnesses. Children with a body mass index (BMI) of >85 percentile from the National Institutes of Health (NIH) 2000 chart were classified as overweight. RESULTS The control and study groups were statistically comparable in mean age (10.97 +/- 3.83 years and 8.07 +/- 2.56 years, respectively) and gender ratio (58 males in each group). Thirty children in the control group and 44 in the study population were overweight (p < .05). Among children with chronic constipation, the group of overweight children was male predominant (70.45% vs 47.36%, p < .05), had increased incidence of psychological/behavioral problems (45.45% vs 22.8%, p < .05), and was more likely to fail treatment (40.9% vs 21.05%, p < .05). There was no significant difference in the clinical profile of constipation, such as mean duration of constipation before presentation, sex ratio, incidence of painful defecation, and soiling and frequency of defecation between these 2 groups. CONCLUSIONS There appears to be an association between chronic severe constipation and being overweight. Children with constipation are more likely to be overweight when compared with controls. Among children with chronic constipation, overweight individuals seem to constitute a distinct clinical group. This group is male predominant, has increased incidence of psychological/behavioral disorders, and is more likely to fail treatment.
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Affiliation(s)
- Sudipta Misra
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, UIC College of Medicine at Peoria, 320 E. Armstrong, Peoria, IL, USA.
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Rajindrajith S, Devanarayana NM, Crispus Perera BJ, Benninga MA. Childhood constipation as an emerging public health problem. World J Gastroenterol 2016; 22:6864-6875. [PMID: 27570423 PMCID: PMC4974585 DOI: 10.3748/wjg.v22.i30.6864] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/16/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.
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Sampaio C, Sousa AS, Fraga LGA, Veiga ML, Bastos Netto JM, Barroso U. Constipation and Lower Urinary Tract Dysfunction in Children and Adolescents: A Population-Based Study. Front Pediatr 2016; 4:101. [PMID: 27752507 PMCID: PMC5046079 DOI: 10.3389/fped.2016.00101] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/06/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between constipation and lower urinary tract dysfunction (LUTD) and nocturnal enuresis in a population-based study. MATERIAL AND METHODS This is a cross-sectional study. The criteria for inclusion were children and adolescents of between 5 and 17 years and who agreed to sign the informed consent form. The study excluded students with neurological problems or who had documented abnormalities of the urinary tract. To identify the presence and severity of LUTD, we used the Voiding Dysfunction Symptom Score (DVSS). To evaluate the presence of constipation, Rome III questionnaire was used. RESULTS We interviewed 829 children and adolescents, of which 416 (50.18%) were male. The mean (SD) age was 9.1 (±2.9) years. The overall prevalence of LUTD was 9.1%, predominantly in girls (15 versus 3.1%, p < 0.001). Constipation was found in 9.4% of boys and 12.4% of girls (p = 0.169). Constipated children were 6.8 times more likely to have LUTD than those not constipated (p < 0.001, coefficient and correlation of 0.411). Constipation was found in 8.2% of children without LUTD and in 35.2% of children with LUTD. We performed multivariate analysis to identify urinary symptoms that are independent predictors of the presence of constipation. The presence of infrequent urination (p = 0.004) and holding maneuvers (p < 0.001) were independent predictors. It was noted also noted that constipated children, according to the Rome III criteria, possess a worse DVSS (p < 0.001). Regarding the presence of nocturnal enuresis, 12.6% of children and adolescents had constipation in association with this symptom. However, this relationship was not statistically significant (p = 0.483). CONCLUSION Constipated children were 6.8 times more likely to have LUTD than those not constipated. Among the urinary symptoms, infrequent voiding and holding maneuvers are independent factors of urinary expressions in constipated children. Children with more severe constipation have more prominent urinary symptoms. The presence of enuresis was not associated with constipation.
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Affiliation(s)
- Clara Sampaio
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Ariane Sampaio Sousa
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Luis Gustavo A Fraga
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Maria Luiza Veiga
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - José Murillo Bastos Netto
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Ubirajara Barroso
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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Sujatha B, Velayutham DR, Deivamani N, Bavanandam S. Normal Bowel Pattern in Children and Dietary and Other Precipitating Factors in Functional Constipation. J Clin Diagn Res 2015; 9:SC12-5. [PMID: 26266179 PMCID: PMC4525568 DOI: 10.7860/jcdr/2015/13290.6025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/27/2015] [Indexed: 01/11/2023]
Abstract
AIM To study the bowel pattern of children in general population and children with habit constipation with respect to food habits and regarding psychosocial aspect of toileting. MATERIALS AND METHODS A prospective descriptive study was done in the Institute of child health and hospital for children, Chennai, with two groups, Functional constipation group and Normal bowel pattern group. The functional group included the children with the age group of 2-12 years, of either sex who fulfilled the ROME III criteria for constipation. Normal bowel pattern group had school children of age group 6-12 years of age and 2-5-year-old children attending OPD for minor ailments. The demographic profile, socioeconomic status, complaints, psychosocial aspects affecting bowel pattern and diet chart were collected and recorded from the parents in proforma. Stool frequency and type of stool passed were recorded for a week, with Bristol stool chart. RESULTS A total of 523 and 131 children were analysed for normal bowel pattern and functional constipation respectively. Data analysis done using SPSS version 15. The prevalence of functional constipation was noted in 13.5% with female preponderance and in the age group of 2-4 years. CONCLUSION Constipation continues to be a problem, mostly under recognised in older population. Psychosocial factors had a significant effect on functional constipation. Skipping breakfast, early toilet training, low intake of vegetables and fruits were other factors of significance leading to constipation.
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Affiliation(s)
- Balamma Sujatha
- Assistant Professor, Department of Paediatrics, Saveetha Medical College, Saveetha University, Thandalam, Chennai, India
| | - Dhakshyani Raghavan Velayutham
- Assistant Professor, Department of Paediatrics, Institute of Child Health and Hospital for Children, Egmore, Chennai, India
| | - Nirmala Deivamani
- Professor, Department of Paediatric Gastroenterology, Institute of Child Health and Hospital for Children, Egmore, Chennai, India
| | - Sumathi Bavanandam
- Professor, Department of Paediatrics, Institute of Child Health and Hospital for Children, Egmore, Chennai, India
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Parent-reported gastro-intestinal symptoms in children with autism spectrum disorders. J Autism Dev Disord 2014; 43:2737-47. [PMID: 23371507 DOI: 10.1007/s10803-013-1768-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The objective of this study is to investigate whether parentally-reported gastro-intestinal (GI) symptoms are increased in a population-derived sample of children with autism spectrum disorders (ASD) compared to controls. Participants included 132 children with ASD and 81 with special educational needs (SEN) but no ASD, aged 10-14 years plus 82 typically developing (TD) children. Data were collected on GI symptoms, diet, cognitive abilities, and developmental histories. Nearly half (weighted rate 46.5 %) of children with ASD had at least one individual lifetime GI symptom compared with 21.8 % of TD children and 29.2 % of those with SEN. Children with ASD had more past and current GI symptoms than TD or SEN groups although fewer current symptoms were reported in all groups compared with the past. The ASD group had significantly increased past vomiting and diarrhoea compared with the TD group and more abdominal pain than the SEN group. The ASD group had more current constipation (when defined as bowel movement less than three times per week) and soiling than either the TD or SEN groups. No association was found between GI symptoms and intellectual ability, ASD severity, ASD regression or limited or faddy diet. Parents report more GI symptoms in children with ASD than children with either SEN or TD children but the frequency of reported symptoms is greater in the past than currently in all groups.
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Kilincaslan H, Abali O, Demirkaya SK, Bilici M. Clinical, psychological and maternal characteristics in early functional constipation. Pediatr Int 2014; 56:588-93. [PMID: 24373103 DOI: 10.1111/ped.12282] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/04/2013] [Accepted: 12/17/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND This cross-sectional study investigated the clinical features of functional constipation (FC) at preschool age, as well as emotional and behavioral characteristics of the children, psychological symptom level and parental attitudes of the mothers, and compared these with that of non-referred typically developing controls with normal intestinal habits. METHODS Participants included 65 children with FC (mean age, 43.6 ± 15.4 months; range, 25-72 months), 59 healthy controls (mean age, 46.9 ± 14.5 months; range, 25-72 months) and the mothers of the children. The Childhood Behavior Checklist, Symptom Checklist 90 and Parental Attitude Research Instrument were filled in by the mothers. RESULTS Participants with FC had higher problem scores than the comparison children in a variety of emotional and behavioral parameters. Approximately half exhibited internalizing and one-third had externalizing problems in the clinical range. The mothers of the patient group had higher levels of psychological distress, overprotective parenting and strict discipline. On multiple logistic regression analysis child psychopathology, maternal education level and maternal distress were independently associated with FC. CONCLUSION Behavior problems are common in children with FC from an early age. Low level of education and high psychological distress of the mothers seem to be important risk factors for constipation and should be assessed carefully in the management of these cases.
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Affiliation(s)
- Huseyin Kilincaslan
- Department of Pediatric Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Yik YI, Leong LCY, Hutson JM, Southwell BR. The impact of transcutaneous electrical stimulation therapy on appendicostomy operation rates for children with chronic constipation--a single-institution experience. J Pediatr Surg 2012; 47:1421-6. [PMID: 22813807 DOI: 10.1016/j.jpedsurg.2012.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 01/13/2012] [Accepted: 01/15/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE Appendicostomy for antegrade continence enema is a minimally invasive surgical intervention that has helped many children with chronic constipation. At our institution, since 2006, transcutaneous electrical stimulation (TES) has been trialed to treat slow-transit constipation (STC) in children. This retrospective audit aimed to determine if TES use affected appendicostomy-formation rates and to monitor changes in practice. We hypothesized that appendicostomy rates have decreased for STC but not for other indications. METHODS Appendicostomy-formation rate was determined for the 5 years before and after 2006. Children were identified as STC or non-STC from nuclear transit scintigraphy and patient records. RESULTS Since 1999, 317 children were diagnosed with STC using nuclear transit scintigraphy with 121 during 2001 to 2005 (24.2/year) and 147 during 2006 to 2010 (29.4/year). Seventy-four children had appendicostomy formation. For 2001 to 2005, appendicostomy-formation rates for STC and non-STC children were similar: 5.4 per year (n = 27) and 4.8 per year (n = 24), respectively. For 2006 to 2010, appendicostomy-formation rates were 1.2 per year (n = 6) for STC and 3.2 per year (n = 16) for non-STC (χ(2), P = .04). CONCLUSION Since 2006, appendicostomy-formation rates have significantly reduced in STC but not in non-STC children at our institute, coinciding with the introduction of TES as an alternative treatment for STC. Transcutaneous electrical stimulation has not been tested on non-STC children in this period.
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Affiliation(s)
- Yee Ian Yik
- F Douglas Stephens Surgical Research and Gut Motility Laboratories, Murdoch Children's Research Institute, Melbourne, Australia
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Abstract
Human defecation involves integrated and coordinated sensorimotor functions, orchestrated by central, spinal, peripheral (somatic and visceral), and enteric neural activities, acting on a morphologically intact gastrointestinal tract (including the final common path, the pelvic floor, and anal sphincters). The multiple factors that ultimately result in defecation are best appreciated by describing four temporally and physiologically fairly distinct phases. This article details our current understanding of normal defecation, including recent advances, but importantly identifies those areas where knowledge or consensus is still lacking. Appreciation of normal physiology is central to directed treatment of constipation and also of fecal incontinence, which are prevalent in the general population and cause significant morbidity.
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Affiliation(s)
- Somnath Palit
- Academic Surgical Unit (GI Physiology Unit), Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University, London, UK.
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Abstract
Constipation remains a frequent presentation to paediatricians, with significant health resource implications. We present a practical guide to the management of paediatric constipation and evaluate the current evidence for treatment regimens, to help the clinician in treating a condition that can be distressing and has a significant impact on affected families.
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Affiliation(s)
- Nadeem A Afzal
- Paediatric Department, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Rd, Southampton, Hants, SO16 6YD, England.
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Chien LY, Liou YM, Chang P. Low defaecation frequency in Taiwanese adolescents: association with dietary intake, physical activity and sedentary behaviour. J Paediatr Child Health 2011; 47:381-6. [PMID: 21309885 DOI: 10.1111/j.1440-1754.2010.01990.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM The objectives of this study were to estimate the prevalence of constipation, defined as less than three defaecations per week, in Taiwanese adolescents and to examine its association with the intake of vegetables, fruits and fluids; time spent on sedentary behaviour; and time spent on moderate and vigorous physical activity. METHODS This study used a questionnaire survey. The study participants were 14,626 adolescents in grades 7-12. Physical activity was measured using the International Physical Activity Questionnaire-Youth Show Card Version. Time spent on sedentary activity included studying, reading, sitting in vehicles and screen time. Consumption of fluid, fruits and vegetables was measured by asking participants to describe the average consumption of each type of food in the past 7 days. RESULTS The prevalence of defaecation frequency of < 3 times a week was 9.3%. Multivariate logistic regression analysis showed that female sex (odds ratio (OR) = 2.2), worse health status (OR = 1.3), not being overweight/obese (OR = 0.7 and 0.3 for overweight and obesity), more time spent on sedentary activity (OR = 1.0) and low intake of fluids (< 1.8 L/day; OR = 1.2), fruits (< 1 portion; OR = 1.6), vegetables (< 1 portion or 100 g; OR = 1.4) and whole-grain products (OR = 1.2) were independently associated with increased risk of low defaecation frequency. CONCLUSIONS The prevalence of low defaecation frequency was high in Taiwanese adolescents. Decreasing sedentary behaviour and increasing the intake of fluids, vegetables, fruits and whole-grain products among those adolescents with very low intake levels could be helpful in preventing and managing constipation, irrespective of body size and health status.
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Affiliation(s)
- Li-Yin Chien
- Institutes of Clinical and Community Health Nursing Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
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Aziz S, Moiz Fakih HA, Di Lorenzo C. Bowel habits and toilet training in rural and urban dwelling children in a developing country. J Pediatr 2011; 158:784-8. [PMID: 21183187 DOI: 10.1016/j.jpeds.2010.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 10/15/2010] [Accepted: 11/04/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the bowel habits and toilet training of developmentally normal children ages 5 to 8 years in rural and urban areas of the province of Sindh, Pakistan. STUDY DESIGN We conducted a descriptive cross-sectional study, conducted at households of rural (District Khairpur) and urban (Karachi) areas of Sindh, Pakistan, which enrolled 1000 children between 5 and 8 years of age, (half from rural and half from urban areas). A questionnaire regarding age, ethnicity, and sex was completed by two separate investigators from each setting. Recall information was elicited about bowel habits for the previous 2 weeks and the frequency and quality of stools, size of stools, and dietary habit for the previous 24 hours. A constipation score that was based on modified Rome III criteria was developed for each child. RESULTS Functional constipation was reported 1.6 times more in the rural than the urban population (P < .001). Toilet training was initiated and completed earlier in the urban (18.6 ± 6.8 and 46 ± 12.5 months) than the rural children (28.6 ± 6.1 and 56.5 ± 6.7 months) (P < .001). The daily calorie, macronutrient, fiber, and water intake was higher in the urban population (P < .001). Functional constipation was significantly (P = .016) negatively correlated (r = -0.076) with the fiber intake. CONCLUSIONS Functional constipation was found more frequently in the rural area. Toilet training was initiated and completed significantly earlier in the urban population.
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Affiliation(s)
- Sina Aziz
- Department of Pediatrics, Dow University of Health Sciences, Karachi, Pakistan.
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Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol 2011; 25:3-18. [PMID: 21382575 DOI: 10.1016/j.bpg.2010.12.010] [Citation(s) in RCA: 563] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 02/07/2023]
Abstract
We aimed to review the published literature regarding the epidemiology of constipation in the general paediatric and adult population and to assess its geographic, gender and age distribution, and associated factors. A search of the Medline database was performed. Study selection criteria included: (1) studies of population-based samples; (2) containing data on the prevalence of constipation without obvious organic aetiology; (3) in paediatric, adult or elderly population; (4) published in English and full manuscript form. Sixty-eight studies met our inclusion criteria. The prevalence of constipation in the worldwide general population ranged from 0.7% to 79% (median 16%). The epidemiology of constipation in children was investigated in 19 articles and prevalence rate was between 0.7% and 29.6% (median 12%). Female gender, increasing age, socioeconomic status and educational level seemed to affect constipation prevalence.
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Affiliation(s)
- Suzanne M Mugie
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH, United States.
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Rajindrajith S, Devanarayana NM. Constipation in children: novel insight into epidemiology, pathophysiology and management. J Neurogastroenterol Motil 2011; 17:35-47. [PMID: 21369490 PMCID: PMC3042216 DOI: 10.5056/jnm.2011.17.1.35] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 12/24/2010] [Accepted: 12/31/2010] [Indexed: 12/12/2022] Open
Abstract
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 diagnosis is often a symptom-based clinical process. Recently developed Rome III diagnostic criteria looks promising, both in clinical and research fields. Laboratory investigations such as barium enema, colonoscopy, anorectal manometry and colonic transit studies are rarely indicated except in those who do not respond to standard management. Treatment of childhood constipation involves several facets including education and demystification, toilet training, rational use of laxatives for disimpaction and maintenance and regular follow-up. Surgical options should be considered only when medical therapy fails in long standing constipation. Since most of the management strategies of childhood constipation are not evidence-based, high-quality randomized controlled trials are required to assess the efficacy of currently available or newly emerging therapeutic options. Contrary to the common belief that children outgrow constipation as they grow up, a sizable percentage continue to have symptoms beyond puberty.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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18
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Chan MF, Chan YL. Investigating factors associated with functional constipation of primary school children in Hong Kong. J Clin Nurs 2010; 19:3390-400. [DOI: 10.1111/j.1365-2702.2010.03362.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ibrahim SH, Voigt RG, Katusic SK, Weaver AL, Barbaresi WJ. Incidence of gastrointestinal symptoms in children with autism: a population-based study. Pediatrics 2009; 124:680-6. [PMID: 19651585 PMCID: PMC2747040 DOI: 10.1542/peds.2008-2933] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To determine whether children with autism have an increased incidence of gastrointestinal symptoms compared with matched control subjects in a population-based sample. DESIGN/METHODS In a previous study including all of the residents of Olmsted County, Minnesota, aged <21 years between 1976 and 1997, we identified 124 children who fulfilled criteria on the basis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for a research diagnosis of autism. Two matched control subjects were identified for each case subject. Through the Rochester Epidemiology Project, all medical diagnoses, are indexed for computerized retrieval. Gastrointestinal diagnoses before 21 years of age were grouped into 5 categories: (1) constipation; (2) diarrhea; (3) abdominal bloating, discomfort, or irritability; (4) gastroesophageal reflux or vomiting; and (5) feeding issues or food selectivity. The cumulative incidence of each category was calculated by using the Kaplan-Meier method. Cox proportional hazards models were fit to estimate the risk ratios (case subjects versus control subjects) and corresponding 95% confidence intervals. RESULTS Subjects were followed to median ages of 18.2 (case subjects) and 18.7 (control subjects) years. Significant differences between autism case and control subjects were identified in the cumulative incidence of constipation (33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs 16.1). No significant associations were found between autism case status and overall incidence of gastrointestinal symptoms or any other gastrointestinal symptom category. CONCLUSIONS As constipation and feeding issues/food selectivity often have a behavioral etiology, data suggest that a neurobehavioral rather than a primary organic gastrointestinal etiology may account for the higher incidence of these gastrointestinal symptoms in children with autism.
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Affiliation(s)
- Samar H Ibrahim
- Division of Pediatric Gastroenterology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abstract
Constipation is a common problem in children. However, there is much controversy surrounding the etiology, diagnosis and treatment of functional constipation observed in childhood. Despite the high frequency of this problem documented in the literature, there is little research that assesses the direct relationship between the food consumed and the eventual stool consistency. Breastfeeding is an excellent way to prevent constipation in infants and toddlers, as is fruit and vegetable consumption in older children. The aim of this review is to investigate available tools in the literature concerning constipation in children and to discuss the relationship between constipation and diet in childhood.
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Affiliation(s)
- Mustafa Inan
- Department of Pediatric Surgery, Trakya Universitesi, Tip Fakultesi, Cocuk Cerrahisi AD Balkan Yerleskesi, 22030, Edirne, Turkey
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Abstract
OBJECTIVES To gather data concerning bowel habits and toilet training of developmentally normal children ages 5 to 8 years. METHODS A questionnaire containing information on age, race, and sex was completed anonymously by a parent in 9 pediatric practices. Recall information was elicited about onset and completion of toilet training, frequency and quality of stooling, size of bowel movements, and behavioral components of defecation. RESULTS Questionnaires were completed for 1142 children. When all of the children were considered together, toilet training started at a mean of 27.2 months and was completed at a mean of 32.5 months. It began and was completed nearly 3 months earlier for girls than for boys (P<0.001). African American children started and completed toilet training at least 6 months earlier than white children (P<0.001). Of the children, 95% defecated either daily or every other day. Straining at defecation and infrequent stooling were reported significantly more often for girls, whereas staining of underclothes and passage of large bowel movements were reported more often in boys. Approximately 10% of children fulfilled criteria for functional constipation. CONCLUSIONS Most of the children between 5 and 8 years of age have a medium-size bowel movement daily or every other day without straining or withholding. Although African American children toilet train at an earlier age than do white children, bowel habits appear to be similar. A sizeable subgroup of children presenting to primary care providers have a history that is consistent with constipation.
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Chao HC, Lai MW, Kong MS, Chen SY, Chen CC, Chiu CH. Cutoff volume of dietary fiber to ameliorate constipation in children. J Pediatr 2008; 153:45-9. [PMID: 18571534 DOI: 10.1016/j.jpeds.2007.12.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 11/19/2007] [Accepted: 12/18/2007] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the proper ingested volume of dietary fiber for relieving constipation in children. STUDY DESIGN During a 3-year period, we prospectively evaluated the correlation of intake volume of dietary fiber with improvement of constipation in children. Patients were categorized into younger (3-7 years) and older (8-14 years) children. The evaluation period lasted 12 weeks. A good improvement was defined as the child exhibiting at least 60% relief of the constipation symptoms during the observation period. Freedom from constipation was observed during the last 4 weeks. RESULTS The study population consisted of 422 patients (213 younger, 209 older), with a mean age of 7.89 +/- 4.71 years. Baseline daily dietary fiber intake of the younger and older groups was 5.97 +/- 2.35 g and 9.83 +/- 3.51 g, respectively. 227 cases (53.8 %) showed improvement of constipation, and 49.1 % of the patients had relief of constipation. Greater intake of dietary fiber was positively associated with good improvement of constipation in both groups (P = .002, and P < .001). Cutoff volumes of daily dietary fiber intake in the relief of constipation were 10 g in the younger group and 14.5 g in the older group. CONCLUSION The cutoff of dietary fiber intake needed to relieve constipation increased with age, achievable in a 12-week intervention.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Reilly DJ, Chase JW, Hutson JM, Clarke MC, Gibb S, Stillman B, Southwell BR. Connective tissue disorder--a new subgroup of boys with slow transit constipation? J Pediatr Surg 2008; 43:1111-4. [PMID: 18558192 DOI: 10.1016/j.jpedsurg.2008.02.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 02/09/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE Slow transit constipation (STC) is a form of chronic constipation, with delayed colonic passage of stool. Possible etiologies include reduced neurotransmitter levels, reduced interstitial cells of Cajal density, or a disorder of connective tissue (CT) synthesis. A common CT disorder is generalized joint hypermobility (GJH). This study aimed to investigate whether there was a greater prevalence of GJH among patients with STC than controls. METHODS Children (aged 7-17) diagnosed with STC by radio/nuclear transit study were recruited from outpatient clinics. Controls (no history of constipation) were recruited from outpatient clinics and a scout jamboree. Hypermobility was assessed using the Beighton score (4 or more = hypermobile). This project received ethical approval by the human research ethics committee. RESULTS Thirty-nine STC subjects and 41 controls were measured. Of 39 STC subjects, 15 (38%) were hypermobile, compared to 8 (20%) of 41 controls (P = .06). Analyzed by gender, 10 (38%) of 26 STC males and 1 (4%) of 23 control males were hypermobile (P < .01). CONCLUSIONS These results show that GJH is higher in STC children, particularly males, suggesting that a disorder of CT synthesis plays a role in the etiology of STC. Further research is required to ascertain the nature of any relationship and how this knowledge may aid our understanding and treatment of STC.
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Affiliation(s)
- Daniel J Reilly
- School of Medicine, University of Melbourne, Melbourne, Victoria 3052, Australia
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Joensson IM, Siggaard C, Rittig S, Hagstroem S, Djurhuus JC. Transabdominal Ultrasound of Rectum as a Diagnostic Tool in Childhood Constipation. J Urol 2008; 179:1997-2002. [DOI: 10.1016/j.juro.2008.01.055] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Soren Rittig
- Department of Pediatrics, Skejby University Hospital, Aarhus, Denmark
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Medeiros LCDS, Morais MBD, Tahan S, Fukushima É, Motta MEFA, Fagundes-Neto U. Características clínicas de pacientes pediátricos com constipação crônica de acordo com o grupo etário. ARQUIVOS DE GASTROENTEROLOGIA 2007; 44:340-4. [DOI: 10.1590/s0004-28032007000400011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Accepted: 02/02/2007] [Indexed: 11/22/2022]
Abstract
RACIONAL: Não existem estudos avaliando as características clínicas de constipação de acordo com os grupos etários pediátricos. OBJETIVO: Avaliar as características da constipação crônica de acordo com o grupo etário. MÉTODOS: Estudo retrospectivo para avaliar informações demográficas e características clínicas de pacientes pediátricos atendidos em ambulatório especializado entre maio de 1995 e dezembro de 2002. Os dados obtidos foram analisados de acordo com o grupo etário (lactentes, pré-escolares, escolares e adolescentes). RESULTADOS: Foram estudados 561 pacientes, predominando o grupo etário de pré-escolares (42,9%), seguido de escolares (26,9%), lactentes (19,1%) e adolescentes (11,0%). Não se observou diferença estatisticamente significante entre os gêneros nas quatro faixas etárias. Menos que três evacuações por semana foi observado em maior percentual nos pré-escolares (65,8%) e escolares (59,6%) do que nos lactentes (52,4%) e adolescentes (43,1%). Escape fecal foi observado em 75,6% dos pré-escolares com idade maior do que 48 meses, 68,2% dos escolares e 76,7% dos adolescentes. Maior freqüência de escape fecal no gênero masculino (80,7%) do que no feminino (50,0%) foi observada apenas no grupo etário de escolares. Comportamento de retenção (67,6%, 40,7%, 27,2%), medo de defecar (70,2%, 44,2%, 29,7%) e dor abdominal (80,8%, 69,6%, 73,6%) foram observados, respectivamente, com maior freqüência nos pré-escolares do que nos escolares e adolescentes. CONCLUSÃO: Observaram-se diferenças nas características clínicas de pacientes com constipação crônica segundo o grupo etário, no entanto, em todas as faixas etárias observou-se duração prolongada da queixa de constipação e elevada freqüência de complicações como dor abdominal e escape fecal.
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Caffarelli C, Coscia A, Baldi F, Borghi A, Capra L, Cazzato S, Migliozzi L, Pecorari L, Valenti A, Cavagni G. Characterization of irritable bowel syndrome and constipation in children with allergic diseases. Eur J Pediatr 2007; 166:1245-52. [PMID: 17345097 DOI: 10.1007/s00431-006-0410-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 12/19/2006] [Indexed: 12/14/2022]
Abstract
Allergy is believed to play a role in the pathogenesis of irritable bowel syndrome (IBS) and constipation. We investigated whether allergic patients are more prone to constipation or IBS. In a multicenter study, two groups of outpatient children aged 3-13 years were included. In group 1, children with allergic symptoms were enrolled. Group 2 consisted of nonallergic children. In both groups, the assessment of IBS and constipation was carried out using a questionnaire based on the Rome criteria for functional gastrointestinal disorders. All children were examined and underwent skin prick tests (SPT) to foods and aeroallergens. The allergic group (n=196) and controls (n=127) were comparable with respect to sex, age, and anthropometric parameters. IBS was found in 6.6% of the allergic children and in 6.3% of the controls (p=0.581). The frequency of constipation was similar in the two groups. In allergic children, positive SPTs to food and self-reported reactions to food were associated with IBS. Our results show that evaluation of constipation comorbidity is not required in allergic children. In allergic children with positive SPT to foods attention may be paid to IBS symptoms.
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Affiliation(s)
- Carlo Caffarelli
- Dipartimento dell'Età Evolutiva, Clinica Pediatrica, Università di Parma, Via Gramsci 14, 43100 Parma, Italy.
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Inan M, Aydiner CY, Tokuc B, Aksu B, Ayvaz S, Ayhan S, Ceylan T, Basaran UN. Factors associated with childhood constipation. J Paediatr Child Health 2007; 43:700-6. [PMID: 17640287 DOI: 10.1111/j.1440-1754.2007.01165.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM To evaluate factors associated with constipation, determine its risk factors and identify common methods of managing constipation among schoolchildren from ages 7-12 in Edirne, Turkey. METHODS This was a cross-sectional and descriptive study and 1900 children were stratified by the school population, age and gender. The questionnaire collected information from parents about the prevalence of constipation and associated factors as well. It asked about bowel movements, socio-demographic data, personal and family stressors, parental concern about constipation, and treatment methods. RESULTS The overall prevalence of constipation was 7.2%. It was 7.3% in boys and 7.2% in girls (P > 0.05). The parameters of siblings with health problems, constipation history in family members, abnormal oral habits, and little regular sporting activity were more common in constipated children than in non-constipated ones (P < 0.05). In the logistic regression analysis, never having used school toilets (OR: 5.9) and having problem to control their bowel after 2 years of age (OR: 3.1) were found to be major risk factors for constipation in schoolchildren ages 7-12 years. Constipated children had a lower consumption rate of fruits and vegetables and a higher consumption rate of milk-group foods, biscuits and macaroni than non-constipated children. Parental concern was at 90% and the rate of medical consultation was 23.2% for constipated children. CONCLUSIONS The risk factors for childhood constipation may be genetic, psychological or organic. Bowel functions may be affected by dietary habits. Parents, health and education professionals should give special attention to childhood constipation.
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Affiliation(s)
- Mustafa Inan
- Department of Pediatric Surgery, Trakya University Faculty of Medicine, Edirne 22030, Turkey.
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Machado NC, Carvalho MDA. Constipação crônica na infância: quanto estamos consultando em Gastroenterologia Pediátrica? REVISTA PAULISTA DE PEDIATRIA 2007. [DOI: 10.1590/s0103-05822007000200003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJETIVO: Comparar dois períodos em relação ao atendimento de constipação crônica - Tempo A (1992 a 1995) e Tempo B (2002 a 2005), avaliando o número de consultas por problemas gastrintestinais; o número e a porcentagem de consultas de crianças com constipação crônica; e o número de atendimentos de crianças com constipação crônica por período de atendimento. MÉTODOS: No Tempo A, 359 pacientes foram atendidos em um período de quatro horas por semana. No Tempo B, 624 pacientes foram atendidos em três períodos de quatro horas, totalizando 12 horas por semana. RESULTADOS: Houve aumento no número absoluto de pacientes, no número de consultas por problemas gastrintestinais (2,8 vezes) e no número de consultas por constipação crônica (2,6 vezes) no Tempo B, em relação ao Tempo A. Houve manutenção na proporção de consultas por constipação crônica: média de 35,6% no Tempo A e 34,6% no Tempo B. Ocorreu aumento no número de períodos de atendimento no Tempo B (2,9 vezes maior), com igual número de consultas por período de atendimento (média de 17,4 no Tempo A e 16,6 no Tempo B) e de consultas por constipação crônica por período de atendimento (média de 6,1 no Tempo A e 5,5 no Tempo B). CONCLUSÕES: O aumento no número absoluto, e não na proporção de atendimentos por constipação crônica, pode ter ocorrido pela manutenção da prevalência populacional deste distúrbio, gerando demanda contida de encaminhamento pelo pediatra generalista. O despreparo do pediatra generalista para o atendimento deste problema poderia levar a um aumento no número de encaminhamentos aos pediatras especialistas.
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Abstract
OBJECTIVE To evaluate the prevalence rates for constipation and faecal and urinary incontinence in children attending primary care clinics in the United States. METHODS Retrospective review of case records of all children, 4-17 years of age, seen for at least one health maintenance visit during a 6 month period and followed from birth or within the first 6 months of age in our clinics. We reviewed all charts for constipation, faecal incontinence and urinary incontinence. RESULTS We included 482 children in the study, after excluding 39 children with chronic diseases. The prevalence rate for constipation was 22.6% and was similar in boys and girls. The constipation was functional in 18% and acute in 4.6%. The prevalence rate for faecal incontinence (> or =1/week) was 4.4%. The faecal incontinence was associated with constipation in 95% of our children. The prevalence rate for urinary incontinence was 10.5%; 3.3% for daytime only, 1.8% for daytime with night-time and 5.4% for night-time urinary incontinence. Faecal and urinary incontinence were significantly more commonly observed in children with constipation than in children without constipation. CONCLUSION The prevalence rates were 22.6% for constipation, 4.4% for faecal incontinence and 10.5% for urinary incontinence in a US primary care clinic. Children with constipation had higher prevalence rates for faecal and urinary incontinence than children without constipation. Boys with constipation had higher rates of faecal incontinence than girls with constipation.
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Affiliation(s)
- Vera Loening-Baucke
- Children's Hospital, JCP 2555, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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de Carvalho EB, Vitolo MR, Gama CM, Lopez FA, Taddei JAC, de Morais MB. Fiber intake, constipation, and overweight among adolescents living in Sao Paulo City. Nutrition 2006; 22:744-9. [PMID: 16815488 DOI: 10.1016/j.nut.2006.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 04/21/2006] [Accepted: 05/03/2006] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study evaluated the dietary fiber intake of adolescents in the metropolitan area of Sao Paulo city and any association between low dietary fiber intake with constipation and overweight. METHODS In total, 716 adolescents were included within the study, of whom 314 attended private school and 402 attended public school. Evaluation of fiber intake was based on a 24-h daily intake record and a frequency questionnaire. Data concerning bowel movements and height and weight measurements were also taken. RESULTS Fiber consumption, below that recommended ("age + 5"), was found in 61.8% and 41.4% (P = 0.000) of girls attending private and public schools, respectively, and in 44.1% and 25.6% of boys (P = 0.001). Adolescents who did not eat beans on more than 4 d/wk presented a higher risk of fiber intake below that recommended (age + 5; P < 0.05), with odds ratios ranging from 10.4 to 14.2 according gender and private or public schooling. Dietary fiber intake below that recommended was associated with a greater risk (P < 0.05) toward overweight in students attending public schooling (odds ratios 2.84 and 2.95 for males and females, respectively). Low dietary fiber intake was not associated with constipation. CONCLUSION Intake of beans more than four times per week is associated with the appropriate level of fiber intake. Dietary fiber intake below the recommendation was not associated with constipation but was associated with being overweight among those students attending public schooling.
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Abstract
OBJECTIVE A systematic review of the published literature was performed to assess the prevalence, incidence, natural history, and comorbid conditions of functional constipation in children. METHODS Articles were identified through electronic searches in Medline, Embase, Cochrane Central Library, Cinhal and PsychInfo databases. Study selection criteria included: (1) epidemiology studies of general population, (2) on the prevalence of constipation without obvious organic etiology, (3) in children from 0 to 18 yr old, and (4) published in English and full manuscript form. RESULTS Eighteen studies met our inclusion criteria. The prevalence of childhood constipation in the general population ranged from 0.7% to 29.6% (median 8.9; inter quartile range 5.3-17.4). The prevalence of constipation defined as defecation frequency of < 3/wk varied from 0.7% to 29.6% (median 10.4; inter quartile range 1.3-21.3). Identified studies originated from North America (N = 4), South America (N = 2), Europe (N = 9), the Middle-East (N = 1), and Asia (N = 2). Variance of gender specific prevalence was reported in seven studies and five of seven studies reported no significant difference between boys and girls. The age group in which constipation is most common could not be assessed with certainty. Socioeconomic factors were not found to be associated with constipation. CONCLUSION Childhood constipation is a common problem worldwide. Most studies report similar prevalence rates for boys and girls. Large epidemiologic studies with the use of generally accepted diagnostic criteria are needed to define the precise prevalence of constipation.
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Affiliation(s)
- Maartje M van den Berg
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
Constipation among children is a prevalent condition, yet poorly understood. There is little empirical evidence for 'best possible' configurations of services. This article presents a survey of Walsall health visitor team members (HVTMs) which aimed to identify the types of advice and care provided to young children with constipation, pathways to care and ideas for service improvement. Most HVTM consultations were parent-initiated. Few GPs referred children to HVTMs. HVTMs most commonly provided advice about fluids and diet -- only one prescribed medication. HVTMs identified the need for early intervention, consistent information for parents and a clear pathway for all health professionals to follow. Currently, a team from the local primary and hospital NHS trusts is developing an integrated care pathway for paediatric constipation. Success of such pathways depends on their adoption by GPs and hospital-based health professionals, and on evidence of efficacy arising from their evaluation.
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Affiliation(s)
- Denise Smith
- Walsall Primary Care Trust, Manor Hospital, West Midlands
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Valicenti-McDermott M, McVicar K, Rapin I, Wershil BK, Cohen H, Shinnar S. Frequency of gastrointestinal symptoms in children with autistic spectrum disorders and association with family history of autoimmune disease. J Dev Behav Pediatr 2006; 27:S128-36. [PMID: 16685179 DOI: 10.1097/00004703-200604002-00011] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This is a cross-sectional study that compares lifetime prevalence of gastrointestinal (GI) symptoms in children with autistic spectrum disorders (ASDs) and children with typical development and with other developmental disabilities (DDs) and examines the association of GI symptoms with a family history of autoimmune disease. A structured interview was performed in 50 children with ASD and 2 control groups matched for age, sex, and ethnicity-50 with typical development and 50 with other DDs. Seventy-four percent were boys with a mean age of 7.6 years (SD, +/-3.6). A history of GI symptoms was elicited in 70% of children with ASD compared with 28% of children with typical development (p <.001) and 42% of children with DD (p =.03). Abnormal stool pattern was more common in children with ASD (18%) than controls (typical development: 4%, p =.039; DD: 2%, p =.021). Food selectivity was also higher in children with ASD (60%) compared with those with typical development (22%, p =.001) and DD (36%, p =.023). Family history of autoimmune disease was reported in 38% of the ASD group and 34% of controls and was not associated with a differential rate of GI symptoms. In the multivariate analysis, autism (adjusted odds ratio (OR), 3.8; 95% confidence interval (CI), 1.7-11.2) and food selectivity (adjusted OR, 4.1; 95% CI, 1.8-9.1) were associated with GI symptoms. Children with ASD have a higher rate of GI symptoms than children with either typical development or other DDs. In this study, there was no association between a family history of autoimmune disease and GI symptoms in children with ASD.
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35
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Chitkara DK, Di Lorenzo C. From the bench to the 'crib'-side: implications of scientific advances to paediatric neurogastroenterology and motility. Neurogastroenterol Motil 2006; 18:251-62. [PMID: 16553581 DOI: 10.1111/j.1365-2982.2005.00751.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Paediatric gastrointestinal motility disorders may present in the neonatal period as the result of a congenital insult that occurred during embryonic development or as a manifestation of an abnormal genetic background. Functional gastrointestinal and motility disorders may also be acquired and present during childhood as the first presentation of a condition that can persist or re-occur throughout adolescence and adulthood. These disorders can have a significant psychological and financial impact on the lives of the affected children and their families. Recently, enteric neuroscience research has advanced the understanding of the pathogenesis and treatment of uncommon congenital or developmental gastrointestinal motility disorders such as Hirschsprung disease and chronic intestinal pseudo-obstruction. In addition, research has contributed to improvements in the understanding of more prevalent functional gastrointestinal disorders in children, such as chronic constipation and functional abdominal pain syndromes. The purpose of this review is to highlight these advances with particular regard to the clinical impact they have in the understanding and management of disorders in the field of paediatric neurogastroenterology and motility.
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Affiliation(s)
- D K Chitkara
- UNC Center for Functional GI and Motility Disorders, Division of Pediatric Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, 27599, USA.
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36
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Catto-Smith AG. 5. Constipation and toileting issues in children. Med J Aust 2006; 182:242-6. [PMID: 15748137 DOI: 10.5694/j.1326-5377.2005.tb06677.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Accepted: 11/22/2004] [Indexed: 12/27/2022]
Abstract
Constipation is common in children, with prevalences ranging from 0.3% up to 28%. In most children, constipation is functional (ie, without objective evidence of a pathological condition). Painful defecation has been proposed as the primary precipitant of functional faecal retention in early childhood. Faecal soiling is often secondary to constipation, and may occur during spontaneous relaxation of the sphincters precipitated by rectal distension. Management in general practice combines behavioural modification techniques with prolonged courses of laxatives. Treatment is usually successful, but may take up to 6-12 months. Significant numbers of children with initially good responses to therapy for constipation relapse in the long term. Long-term relapse is more frequent in children under 4 years at onset of symptoms and in whom there is a history of faecal soiling associated with constipation.
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Affiliation(s)
- Anthony G Catto-Smith
- Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia.
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37
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Oliveira JN, Tahan S, Goshima S, Fagundes-Neto U, Morais MBD. Prevalência de constipação em adolescentes matriculados em escolas de São José dos Campos, SP, e em seus pais. ARQUIVOS DE GASTROENTEROLOGIA 2006; 43:50-4. [PMID: 16699619 DOI: 10.1590/s0004-28032006000100013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
RACIONAL: Existem poucas informações a respeito da constipação em adolescentes. OBJETIVO: Avaliar a prevalência de constipação em adolescentes matriculados em escolas de São José dos Campos, SP, Brasil, e a concomitância de constipação em seus pais biológicos. MÉTODOS: Neste estudo transversal foi analisada amostra de conveniência composta por alunos com idade entre 9 anos e 9 meses e 18 anos e 7 meses e seus respectivos pais biológicos em cinco escolas de São José dos Campos. Para a coleta dos dados foi utilizado um questionário individual. Foram analisados 372 adolescentes cujos pais também responderam ao questionário. Constipação foi caracterizada quando o adolescente apresentava eliminação de fezes com consistência obrigatoriamente endurecida e a ocorrência de pelo menos uma das seguintes características: dor ou dificuldade para evacuar, escape fecal e sangue em torno das fezes. Fezes com formato de cíbalos ou em pelotas grandes e secas e intervalo entre as evacuações maior ou igual a três dias foram considerados critérios que isoladamente caracterizavam constipação. Para os pais, constipação foi caracterizada de acordo com os critérios de Roma II. RESULTADOS: A prevalência de constipação nos adolescentes foi igual a 22,3%, sendo mais freqüente no sexo feminino (27,4%) do que no masculino (14,9%). Constipação nos pais (7,3%; 20/274) foi menos freqüente do que nas mães (27,3%; 88/322). Observou-se concordância muito leve quanto à concomitância de constipação no adolescente e em sua mãe (kappa = 0,12) e à concomitância de constipação no adolescente e em seu pai (kappa = 0,05). CONCLUSÕES: Constipação intestinal é um distúrbio prevalente neste grupo de adolescentes. Não se constatou concordância relevante entre constipação nos adolescentes e em seus pais biológicos.
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Corazziari E, Staiano A, Miele E, Greco L. Bowel frequency and defecatory patterns in children: a prospective nationwide survey. Clin Gastroenterol Hepatol 2005; 3:1101-6. [PMID: 16271341 DOI: 10.1016/s1542-3565(05)00848-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Very little is known about several aspects of bowel habits in the general pediatric population and the aim of this nationwide survey was to assess bowel frequency and modalities of defecation in children. METHODS The survey was conducted by 58 pediatricians who were selected randomly and distributed evenly throughout Italy. The following items were reported by each pediatrician in a standardized questionnaire: sociodemographic data, frequency and modalities of bowel evacuation, and anorectal disorders. RESULTS The response rate of available completed questionnaires was distributed evenly for the 1-year age group and was 94% (number of patients, 2680; 1-2 years, 442; females, 49.8%). Mean bowel frequency did not vary in the first 2 years of life, it decreased (P = .00001) after the second year, and remained stable until the 12th year; it did not differ between sexes. Mean bowel frequency was reduced significantly in children, both in those younger or older than 2 years, with a positive history of constipation in the parents (P = .00002). Bowel frequency was inversely correlated with the number of persons living and the number of rooms in the child's house (P < .05, P = .008, respectively). Stool consistency, duration of evacuation, and frequency of episodes of painful defecation showed an inverse relationship (P < .001) with bowel frequency. Bowel frequency was significantly lower (P < .001) in children with anorectal disorders. CONCLUSIONS In Italian children, bowel frequency does not differ between sexes but it differed between the first 2 years of life and age older than 2. Anorectal disorders increase as bowel frequency decreases.
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Affiliation(s)
- Enrico Corazziari
- Department of Pediatrics, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
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39
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Lundblad B, Hellström AL. Perceptions of school toilets as a cause for irregular toilet habits among schoolchildren aged 6 to 16 years. THE JOURNAL OF SCHOOL HEALTH 2005; 75:125-8. [PMID: 15987005 DOI: 10.1111/j.1746-1561.2005.tb06656.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Irregular bladder and bowel habits can contribute to urinary and bowel problems. Schoolchildren undergoing treatment for these problems often do not follow the recommendation of regular toilet visits at school, claiming negative perceptions of school toilets. This study examined 6- to 16-year-old schoolchildren's perceptions of school toilets and whether the perceptions affect bladder and bowel habits at school Some 385 Swedish schoolchildren aged 6 to 16 years were surveyed using a semistructured questionnaire. Children aged 13 to 16 years had the most negative perceptions. Twenty-five percent (overall 16%) of older children reported never using the school toilet to urinate, and 80% (overall 63%) never used it to defecate. Perceptions of sight and smell and emotional constraints hindered children from using the school toilets. Children generally based their perceptions of school toilets on physical appearance, offensive smell, and feelings of insecurity. Children's perceptions affected their toilet habits and would rather endure physical discomfort than the psychological and social discomfort of using the school toilet. Children already suffering from urinary tract or intestinal problems face particular difficulties without regular toilet visits during the day.
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Affiliation(s)
- Barbro Lundblad
- Institute of Nursing, Faculty of Health and Caring Sciences, The Sahlgrenska Academy at Göteborg University, Box 457, SE 405 30, Göteborg, Sweden.
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40
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Borowitz SM, Cox DJ, Kovatchev B, Ritterband LM, Sheen J, Sutphen J. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics 2005; 115:873-7. [PMID: 15805358 DOI: 10.1542/peds.2004-0537] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Childhood constipation accounts for 3% of visits to general pediatric clinics and as many as 30% of visits to pediatric gastroenterologists. The majority of children who experience constipation and whose caregivers seek medical care are seen by primary care physicians such as pediatricians or family physicians. Little is known about how primary care physicians treat childhood constipation or the success of their treatments. With this study, we prospectively examined which treatments primary care physicians prescribe to children who present for the first time with constipation and how effective those treatments are. METHODS A total of 119 children who were between 2 and 7 years of age (mean: 44.1 +/- 13.6 months) and presented to 26 different primary care physicians (15 pediatricians and 11 family physicians) for the treatment of constipation for the first time participated in this study. Parents completed daily diaries of their child's bowel habits for 2 weeks before starting treatment recommended by their primary care physician and again 2 months after treatment. The prescribed treatment was identified by reviewing office records of the treating physicians. RESULTS After 2 months of treatment, 44 (37%) of 119 children remained constipated. In the majority (87%) of cases, physicians prescribed some form of laxative or stool softener. The most commonly prescribed laxatives were magnesium hydroxide (77%), senna syrup (23%), mineral oil (8%), and lactulose (8%). In nearly all cases, a specific fixed dose of laxative was recommended; in only 5% of cases were parents instructed clearly to adjust the dose of laxative up or down to get the desired effect. In approximately half of the cases, physicians recommended some sort of dietary intervention. Some form of behavioral intervention was mentioned in the office records of approximately one third of cases; however, in most cases, little detail was provided. In 45% of cases, physicians prescribed disimpaction using oral cathartics, enemas, or suppositories followed by daily laxatives. In 35% of cases, physicians prescribed daily laxatives without any disimpaction procedure. In the remainder, physicians prescribed only dietary changes (5%), the use of intermittent laxatives (9%), or no therapy (7%). Treatment success corresponded to how aggressively the child was treated. Specifically, children who underwent some form of colonic evacuation followed by daily laxative therapy were more likely to have responded to treatment than were those who were treated less aggressively. CONCLUSION Primary care physicians tend to undertreat childhood constipation. After 2 months of treatment, nearly 40% of constipated children remain symptomatic.
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Affiliation(s)
- Stephen M Borowitz
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908, USA.
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41
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Urganci N, Akyildiz B, Polat TB. A comparative study: the efficacy of liquid paraffin and lactulose in management of chronic functional constipation. Pediatr Int 2005; 47:15-9. [PMID: 15693860 DOI: 10.1111/j.1442-200x.2004.02001.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To determine and compare efficacy, safety and optimal dose of two laxatives, liquid paraffin and lactulose, in 40 children with chronic functional constipation. METHODS A total of 20 children were treated with liquid paraffin and 20 with lactulose for 8 weeks and at an initial dose of 1 mL/kg per day for both drugs. The dose was adjusted every 3 days as required and a diary was kept to monitor dose, side-effects, stool frequency and consistency, and other symptoms. RESULTS During first 4 weeks, improvement in stool consistency and frequency was significantly higher in liquid the paraffin group (P < 0.01 and P < 0.05, respectively). Improvement in the number of stools per week was also significantly higher in the liquid paraffin group during the last 4 weeks of therapy (P < 0.05). Compliance rates averaged 95% in the liquid paraffin group and 90% in the lactulose group during the first 4 weeks of therapy and 90% in the liquid paraffin group and 60% in the lactulose group during the last 4 weeks of therapy (chi(2) = 4.8, SD = 1, P = 0.02). During the first 4 weeks of therapy and during the last 4 weeks of therapy, mostly side-effects and poor symptom control, respectively, influenced the compliance in the liquid paraffin group. CONCLUSIONS Liquid paraffin is more effective in the treatment of children with constipation. Patients treated with liquid paraffin responded more rapidly than patients responding to lactulose and showed fewer side-effect. It is considered that late response and side-effects in conjunction with poor symptom control influence the patient compliance and the successful treatment of childhood constipation.
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Affiliation(s)
- Nafiye Urganci
- Clinic of Pediatrics, Sisli Etfal Hospital, Istanbul, Turkey.
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42
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Affiliation(s)
- M A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.
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43
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Borowitz SM, Sutphen JL. Recurrent vomiting and persistent gastroesophageal reflux caused by unrecognized constipation. Clin Pediatr (Phila) 2004; 43:461-6. [PMID: 15208751 DOI: 10.1177/000992280404300507] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over a 2-year period, 34 children were referred to the division of pediatric gastroenterology at the University of Virginia with chronic upper gastrointestinal symptoms whose symptoms rapidly and completely resolved when their unrecognized constipation was treated. The average age at presentation was 8.24 (SD 0.78) years and average duration of upper intestinal symptoms was 15.6 (SD 3.5) months. Twenty-six of 34 had experienced recurrent vomiting, 6 complained of chronic nausea, 17 had chronic symptoms of gastroesophageal reflux, and 20 complained of chronic or recurrent abdominal pain, most often in the epigastric region. Smaller numbers had experienced early satiety, choking, gagging, dysphagia, or intermittent diarrhea. Given the prevalence of constipation in childhood, it seems likely that many children who experience chronic upper intestinal symptoms may be suffering from chronic unrecognized constipation as the cause of their upper intestinal symptoms.
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Affiliation(s)
- Stephen M Borowitz
- Division of Pediatric Gastroenterology, University of Virginia, Charlottesville, Virginia 22908, USA
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44
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Abstract
There is very little evidence for the effects of dietary fibre in young children and current dietary guidelines are based on assumptions and data extrapolated from studies in adults. The first years of life may be critical for the establishment of a healthy colonic microflora, as well as good eating habits. The lack of clear and well-founded guidelines for the intake of dietary fibre in childhood may hinder both factors. The fears that a high-fibre diet in children < 5 years of age will lead to growth faltering and mineral imbalance are not well supported in the literature, especially for children in the developed world. Indeed, with the rising levels of obesity, fibre intake may be of benefit in reducing energy intake. A low-fibre diet may also be implicated in the aetiology of childhood constipation and appendicitis. The latest proposals for the definition of dietary fibre include oligosaccharides, which may act as prebiotics. There are potential health benefits of including oligosaccharides in the diets of infants and children, but more research is needed to consider the long-term effects. The immature intestine of the infant may also result in a greater amount of starch entering the colon during weaning, and this starch would now be considered dietary fibre under the new definitions. Much new research is needed to allow adequate recommendations for the intake of dietary fibre in childhood based on data collected in appropriate age-groups.
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Affiliation(s)
- C A Edwards
- Department of Human Nutrition, Glasgow University, Yorkhill Hospitals, Glasgow G3 8SJ.
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45
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Abstract
A careful history and physical examination will help to differentiate between encopresis with or without constipation and fecal incontinence caused by anatomic or organic disease. Most children with encopresis with or without functional constipation require no or minimal laboratory workup. Successful treatment of encopresis requires a combination of parent and child education, behavioral intervention, medical therapy, and long-term compliance with the treatment regimen. The conventional treatment approach consists of behavior modification and laxative for children with encopresis with constipation and behavior modification alone for the few children with encopresis without constipation. Almost every patient will experience dramatic improvement in encopresis. Recovery rates are 30% to 50% after 1 year and 48% to 75% after 5 years.
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Affiliation(s)
- Vera Loening-Baucke
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Iowa, Iowa City, 52242-1083, USA.
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46
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Guimarães EV, Goulart EM, Penna FJ. Dietary fiber intake, stool frequency and colonic transit time in chronic functional constipation in children. Braz J Med Biol Res 2001; 34:1147-53. [PMID: 11514838 DOI: 10.1590/s0100-879x2001000900007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The objective of the present study was to evaluate associations between fiber intake, colonic transit time and stool frequency. Thirty-eight patients aged 4 to 14 years were submitted to alimentary evaluation and to measurement of colonic transit time. The median fiber intake of the total sample was age + 10.3 g/day. Only 18.4% of the subjects presented a daily dietary fiber intake below the levels recommended by the American Health Foundation. In this group, the median left colonic transit time was shorter than in the group with higher dietary fiber intake (11 vs 17 h, P = 0.067). The correlation between stool frequency and colonic transit time was negative and weak for left colon (r = -0.3, P = 0.04), and negative and moderate for rectosigmoid and total colon (r = -0.5, P<0.001 and r = -0.5, P<0.001, respectively). The stool frequency was lower in the group with slow transit time (0.8 vs 2.3 per week, P = 0.014). In conclusion, most patients with chronic functional constipation had adequate dietary fiber intake. The negative correlation between stool frequency and colonic transit time increased progressively from proximal segments to distal segments of the colon. Patients with normal and prolonged colonic transit time differ in terms of stool frequency.
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Affiliation(s)
- E V Guimarães
- Setor de Gastroenterologia Pediátrica, Departamento de Pediatria, Hospital de Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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47
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Sharif F, Crushell E, O'Driscoll K, Bourke B. Liquid paraffin: a reappraisal of its role in the treatment of constipation. Arch Dis Child 2001; 85:121-4. [PMID: 11466186 PMCID: PMC1718886 DOI: 10.1136/adc.85.2.121] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F Sharif
- Children's Research Centre, Our Lady's Hospital for Sick Children, and Department of Paediatrics, The Conway Institute for Biomedical and Biomolecular Research, University College Dublin, Ireland
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48
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Abstract
Constipation in children is a common concern. There is no single treatment; many children do not respond and continue to have chronic problems. This lack of response is multifactorial, but it is most likely related to the fact that the exact pathophysiology of constipation in children is not known. Diagnostic criteria (Rome II classification) and algorithms proposed by the North American Society for Pediatric Gastroenterology and Nutrition (NASPGN) for evaluation and treatment of children with constipation were recently published and are summarized here. The effectiveness of new treatments such as dietary interventions, prokinetic agents, biofeedback, and polyethylene-glycol electrolyte (PEG) solutions is discussed in this review.
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Affiliation(s)
- S Nurko
- Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Boston, MA 02115, USA.
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