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Pediatric Constipation Differential Diagnoses

  • Author: Stephen M Borowitz, MD; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: Sep 09, 2015
 
 

Diagnostic Considerations

The differential diagnosis of childhood constipation can be extensive and may include Hirschsprung disease (ie, congenital megacolon), spinal or neuromuscular abnormalities (eg, spinal muscular atrophy, tethered cord, Currarino triad [rectal stenosis, hemi sacrum, presacral mass], cerebral palsy [static encephalopathy]), hypothyroidism, anal stenosis, imperforate anus with fistula, anterior displacement of the anus (this is a controversial diagnosis), allergy or sensitivity to cow's milk, and celiac disease. Other conditions to consider include mitochondrial disorders, neuronal intestinal dysplasia, and prune-belly syndrome.

Fortunately, in most cases in which an underlying condition causes constipation, other stigmata of the disorder point to diagnosis. For example, constipation is rarely the only symptom of hypothyroidism.

For practical purposes, in an otherwise healthy child, the differential diagnosis of chronic constipation is Hirschsprung disease and functional constipation (not Hirschsprung disease). Although this differentiation may sometimes be difficult, numerous clues in the history and physical examination are helpful. The image below details the differences between functional constipation and Hirschsprung disease.

See also Constipation and Surgery for Pediatric Constipation and Bowel Management.

This table differentiates functional constipation This table differentiates functional constipation from Hirschsprung disease.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Stephen M Borowitz, MD Professor of Pediatrics and Public Health Sciences, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Virginia School of Medicine

Stephen M Borowitz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Chris A Liacouras, MD Director of Pediatric Endoscopy, Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Chris A Liacouras, MD is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

References
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Plain abdominal radiograph that demonstrates stool throughout the colon.
This table differentiates functional constipation from Hirschsprung disease.
This unprepared single-contrast barium enema demonstrates a transition zone consistent with Hirschsprung disease.
The images illustrate normal anorectal manometry with relaxation of the internal anal sphincter in response to rectal distention.
This image delineates common withholding behaviors in young children.
Contrast enema of a patient with megasigmoid and impacted stool.
Contrast enema in a patient in whom the rectosigmoid was resected.
Position for enema administration in an infant.
Another position for enema administration.
Administration of an enema.
Incorrect enema administration. The enema is administered against stool impaction and cannot be successful.
Enema administration with a tube.
Enema with inflated Foley balloon catheter.
Administration of an enema against impacted stool.
Administration of an enema against fecal impaction.
 
 
 
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