eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Constipation: Follow-up

Author: Stephen Borowitz, MD, Professor of Pediatrics and Public Health Sciences, Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Virginia
Contributor Information and Disclosures

Updated: Oct 30, 2009

Follow-up

Further Outpatient Care

  • Assessment of constipation after disimpaction assures that the prescribed therapy was effective. At that time, maintenance laxative therapy can be prescribed.
  • When the patient has bowel movements regularly for weeks or months without apparent pain, fear, or excessive straining, attempting to discontinue laxative therapy is reasonable.

Patient Education

  • Educating the family that using laxatives continuously for months may be necessary is important. This is particularly true among toddlers, because many months may pass before the association between fear and defecation is extinguished. Reassuring caregivers as to the safety of long-term laxative use and reinforcing the need for persistence is very important. Repeatedly address specific concerns regarding laxative dependency and the risk of colon cancer.
  • Inform the family that relapses are common and are associated with changes in the child's daily routine (eg, vacations) and may occur during times of stress. Also, inform the family that the requirement of intermittent therapy with laxatives into adulthood is not unusual.
  • For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article, Constipation in Children.

Miscellaneous

Medicolegal Pitfalls

  • Perform a digital rectal examination on every young child with chronic constipation to exclude underlying anatomic abnormalities that might account for the constipation, such as an imperforate anus with perineal fistula, intestinal obstruction (mass effect), or Hirschsprung disease.
 


More on Constipation

Overview: Constipation
Differential Diagnoses & Workup: Constipation
Treatment & Medication: Constipation
Follow-up: Constipation
Multimedia: Constipation
References
[ CLOSE WINDOW ]

References

  1. [Guideline] North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. Sep 2006;43(3):405-7. [Medline].

  2. Benninga M, Candy DC, Catto-Smith AG, et al. The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr. Mar 2005;40(3):273-5. [Medline].

  3. [Best Evidence] van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol. Oct 2006;101(10):2401-9. [Medline].

  4. Borowitz SM, Cox DJ, Kovatchev B, et al. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics. Apr 2005;115(4):873-7. [Medline].

  5. Issenman RM, Hewson S, Pirhonen D, et al. Are chronic digestive complaints the result of abnormal dietary patterns? Diet and digestive complaints in children at 22 and 40 months of age. Am J Dis Child. Jun 1987;141(6):679-82. [Medline].

  6. Loening-Baucke V. Prevalence rates for constipation and faecal and urinary incontinence. Arch Dis Child. Jun 2007;92(6):486-9. [Medline].

  7. Saps M, Sztainberg M, Di Lorenzo C. A prospective community-based study of gastroenterological symptoms in school-age children. J Pediatr Gastroenterol Nutr. Oct 2006;43(4):477-82. [Medline].

  8. Yong D, Beattie RM. Normal bowel habit and prevalence of constipation in primary-school children. In: Ambulatory Child Health. Vol 4. 1998:277-82.

  9. de Araujo Sant Anna AM, Calcado AC. Constipation in school-aged children at public schools in Rio de Janeiro, Brazil. J Pediatr Gastroenterol Nutr. Aug 1999;29(2):190-3. [Medline].

  10. Borowitz SM, Cox DJ, Tam A, et al. Precipitants of constipation during early childhood. J Am Board Fam Pract. May-Jun 2003;16(3):213-8. [Medline].

  11. De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr. Jun 2005;146(6):787-92. [Medline].

  12. Abrahamian FP, Lloyd-Still JD. Chronic constipation in childhood: a longitudinal study of 186 patients. J Pediatr Gastroenterol Nutr. Jun 1984;3(3):460-7. [Medline].

  13. Loening-Baucke V. Polyethylene glycol without electrolytes for children with constipation and encopresis. J Pediatr Gastroenterol Nutr. Apr 2002;34(4):372-7. [Medline].

  14. Corkins MR. Are diet and constipation related in children?. Nutr Clin Pract. Oct 2005;20(5):536-9. [Medline].

  15. Iacono G, Cavataio F, Montalto G, et al. Intolerance of cow's milk and chronic constipation in children. N Engl J Med. Oct 15 1998;339(16):1100-4. [Medline].

  16. Lloyd B, Halter RJ, Kuchan MJ, et al. Formula tolerance in postbreastfed and exclusively formula-fed infants. Pediatrics. Jan 1999;103(1):E7. [Medline].

  17. Vandenplas Y, Benninga M. Probiotics and functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr. Apr 2009;48 Suppl 2:S107-9. [Medline].

  18. Muller-Lissner SA. Adverse effects of laxatives: fact and fiction. Pharmacology. Oct 1993;47 Suppl 1:138-45. [Medline].

  19. Schiller LR. Clinical pharmacology and use of laxatives and lavage solutions. J Clin Gastroenterol. Jan 1999;28(1):11-8. [Medline].

  20. Dupont C, Leluyer B, Amar F, et al. A dose determination study of polyethylene glycol 4000 in constipated children: factors influencing the maintenance dose. J Pediatr Gastroenterol Nutr. Feb 2006;42(2):178-85. [Medline].

  21. Felt B, Wise CG, Olson A, et al. Guideline for the management of pediatric idiopathic constipation and soiling. Multidisciplinary team from the University of Michigan Medical Center in Ann Arbor. Arch Pediatr Adolesc Med. Apr 1999;153(4):380-5. [Medline].

  22. Gattuso JM, Kamm MA. Adverse effects of drugs used in the management of constipation and diarrhea. Drug Saf. Jan 1994;10(1):47-65. [Medline].

  23. Khan S, Campo J, Bridge JA, et al. Long-term outcome of functional childhood constipation. Dig Dis Sci. Jan 2007;52(1):64-9. [Medline].

  24. Loening-Baucke V. Constipation in children. N Engl J Med. Oct 15 1998;339(16):1155-6. [Medline].

  25. Pijpers MA, Tabbers MM, Benninga MA, Berger MY. Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures. Arch Dis Child. Feb 2009;94(2):117-31. [Medline].

  26. Staiano A, Andreotti MR, Greco L, et al. Long-term follow-up of children with chronic idiopathic constipation. Dig Dis Sci. Mar 1994;39(3):561-4. [Medline].

  27. Sutphen JL, Borowitz SM, Hutchison RL, Cox DJ. Long-term follow-up of medically treated childhood constipation. Clin Pediatr (Phila). Nov 1995;34(11):576-80. [Medline].

  28. van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol. Oct 2006;101(10):2401-9. [Medline].

  29. Voskuijl W, de Lorijn F, Verwijs W, et al. PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controlled, multicentre trial. Gut. Nov 2004;53(11):1590-4. [Medline].

  30. Wald A. Is chronic use of stimulant laxatives harmful to the colon?. J Clin Gastroenterol. May-Jun 2003;36(5):386-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

constipation, acquired megacolon, functional constipation, functional megacolon, megacolon, stool hoarding, stool retention, stool withholding, Hirschsprung disease, defecation, fecal incontinence, abdominal mass, rectal fecal mass, treatment, diagnosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Stephen Borowitz, MD, Professor of Pediatrics and Public Health Sciences, Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Virginia
Stephen Borowitz, MD is a member of the following medical societies: American Academy of Pediatrics, American Gastroenterological Association, American Pediatric Society, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Chris A Liacouras, MD, Director of Pediatric Endoscopy, Department of Pediatrics, Division of Gastroenterology and Nutrition, Associate Professor, Children's Hospital of Philadelphia and University of Pennsylvania
Chris A Liacouras, MD is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing 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, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor

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, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.