Constipation

Abstract

Constipation is defined as a stool frequency of less than 3 times per week. These patients will have bulky, hard, dry bowel movements that can be painful to pass. The age range for this diagnosis can obviously be from a newborn infant to an older child, though the most common age of presentation is between 1 and 5 years. The work up and management is often dependent on the age of the patient. Most children with constipation are well managed by pediatricians and pediatric gastroenterologists. The patients that are referred to the pediatric surgeon are often those who rarely or never have bowel movements without some mechanical assistance, either orally or per rectum. They may have had difficulty since birth or gradually developed worsening constipation as they transitioned off breast milk or formula and onto cow's milk. Sometimes they will have a diagnosis that might indicate the possibility of a functional disorder of the colon, such as gastroschisis, Hirschsprung disease or cystic fibrosis. Rectal sphincter disorders, such as imperforate anus, cloacal anomalies and myelomeningocele also contribute to constipation issues. There are children who have conditions such as trisomy 21 and cerebral palsy and who are more likely to be constipated. Finally, children with complex neuromuscular disorders (muscular dystrophy, spinal muscular atrophy, intestinal pseudo-obstruction), might require surgical assistance with the problems of constipation. © 2011 Springer Science+Business Media, LLC.