Investigation and management of long-standing chronic constipation in childhood

Abstract

The anorectal physiology of 106 children with long-standing chronic constipation, who had failed to respond to a trial of medical treatment, was assessed. 10 (9%) were shown to have ultrashort-segment Hirschsprung's disease, later confirmed on histology. The remainder showed evidence of hypertrophy of the internal sphincter on anorectal manometry and had a vigorous anal dilatation (to accept 4 fingers) under general anaesthesia. After this, 38% were able to be weaned off all medication and most of the remainder improved. Further anal dilatation and internal sphincterotomy allowed a further 10 children to stop laxatives, bringing the total to 48%.