Evaluation and Management of Intractable Constipation in Children

Abstract

Intractable constipation has a negative impact on quality of life and well-being of children. The evaluation includes a thoroughhistory and physical examination with diagnostic testing to rule out metabolic, systemic, anatomic, and neurological etiologies. Inchildren with refractory symptomswhofailed aggressive medical management, colonic transit studies help guide need for invasivetesting. Manometric testing of the anorectum and the colon are recommended to evaluate for enteric neuromuscular compromiseand guide novel medical and surgical therapies. Goals of management are to facilitate colonic emptying, ensure fecal continence,and preserve colonic neuromuscular integrity. Treatments range from aggressive medical therapy with stimulant laxatives thatmodify transit to antegrade continence enemas that facilitate colonic emptying. Surgery, including diverting ostomy and resection,has a limited role and should only be considered in select patients after medical and manometric evaluation. The aim of this articleis to provide an update on the evaluation and management of childhood intractable constipation.

Keywords

• constipation
• children
• refractory