The pathophysiology of constipation

Abstract

Constipation is an extremely common disorder in childhood and is responsible for up to 25% of all pediatric gastroenterological consultations and 3% of all pediatric outpatient visits. In 90% of the cases the disorder is functional in origin and in only 10% is there an underlying organic disorder. Common organic causes of childhood constipation include: congenital defects of the gut; neurologic disease especially cerebral palsy, spinal cord disorders and hypotonia; endocrine and metabolic disorders (hypothyroidism, cystic fibrosis, hypercalcemia, diabetes mellitus, renal acidosis), and the use of constipating drugs such as some antacids, sucralfate, iron, codeine-containing medications, imipramine, phenytoin, etc. The commonest of the congenital defects is Hirschsprung's disease, which has an incidence of 1 in 4,500 live births compared to 1 in 7,000 live births with anorectal malformations, and 1 in 40,000 with other enteric neuromuscular disorders. Fewer than 5% of children presenting for the first time with constipation have demonstrable organic disease. Copyright © 2007 Nestec Ltd., Vevey/S. Karger AG.