Pharmacological management of childhood constipation: Bridging today’s gaps with tomorrow’s therapies

Abstract

Childhood constipation is a prevalent yet frequently underestimated global health concern, affecting approximately 10% of children across diverse populations. Its impact extends well beyond bowel-related symptoms, with affected children often experiencing extraintestinal manifestations such as pain in multiple sites, behavioral disturbances, and a markedly diminished quality of life. The burden is further compounded in low- and middle-income countries, where financial and logistical constraints limit access to effective treatment. The impact is intensified in developing countries due to limited healthcare resources and the unavailability of pharmacological agents. When left untreated or poorly managed, functional constipation (FC) can lead to significant long-term consequences, including persistent bowel dysfunction, psychological disorders, and progression to chronic constipation and other disorders of gut-brain interaction later in life. Pathophysiology of FC is multifactorial, involving factors such as stool withholding behavior, dietary habits, anorectal dysfunction, and psychological factors. Hence, management of FC is multifaceted, including both pharmacological and non-pharmacological interventions. Pharmacological management remains central to treatment, aimed at relieving symptoms and preventing adverse outcomes. However, current therapeutic strategies rely predominantly on a narrow range of osmotic and stimulant laxatives. Introducing new drugs that have often been shown to be effective in adults, have been found to have limited efficacy in children, with some performing no more effectively than a placebo in clinical trials. This highlights a substantial gap in pediatric pharmacotherapy and emphasizes the pressing need for new, evidence-based interventions tailored to the unique physiological and developmental characteristics of children. In this review, we critically examine the current pharmacologic options for managing childhood constipation, assess their limitations, and explore future directions of these drugs and other novel interventions for the development of more effective, accessible, and child-appropriate treatments for this common yet impactful condition.

Keywords: Child; Constipation; Drugs; Management; Pediatric; Pharmacological management; Therapies

Core Tip: Functional constipation ranks among the most common disorders associated with gut-brain interactions in children. Despite the existence of well-documented guidelines featuring structured pharmacological management algorithms, long-term outcomes remain unsatisfactory. To bridge the gap, we must consider the following questions: Why is it necessary to change how we approach childhood constipation? Why have most new pharmacological treatments not proven their effectiveness? What new adjustments are needed in clinical trials related to childhood constipation? What alternative strategies can pediatricians and researchers use to implement novel drugs in children? This review highlights current pharmacological treatments for childhood constipation, including osmotic laxatives, stimulant laxatives, lubricants, and enemas, and aims to bridge the therapeutic gap with novel agents such as prucalopride, lubiprostone, and botulinum toxin. Furthermore, pediatric use of medications emerging in adult studies, such as prosecretory drugs like linaclotide and tenapanor, is discussed.