Childhood constipation: Current status, challenges, and future perspectives

Abstract

Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.

Keywords: Constipation; Children; Functional gastrointestinal disorders; Psychological stress; Treatment; Surgical interventions

Core Tip: Constipation is a public health problem. It has a high prevalence and a multitude of risk factors. The main pathophysiological mechanisms are stool withholding and colonic and anorectal dysfunction in younger and older children, respectively. Constipation is a clinical diagnosis based on the Rome IV criteria. Polyethylene glycol-based therapy is the mainstay in the management of constipation, while other osmotic and stimulant laxatives are used as adjunct therapies. Colonic washouts and surgical interventions are reserved for refractory constipation. A well-planned preventive strategy is useful in preventing functional constipation in children and would be able to reduce healthcare costs and improve health-related quality of life.