How do you treat functional constipation in children?

There are many laxative medicines available to treat children with functional constipation including stool softeners, osmotic laxatives, stimulant laxatives, secretagogue laxatives and rectal therapies . Examples include docusate sodium.

What is the difference between functional constipation and chronic constipation?

Unlike functional constipation, where underlying factors may be apparent, chronic idiopathic constipation lacks a clear physiological or anatomical explanation for the persistent discomfort and irregularity in defecation . An underlying cause is identified in <5% of cases.

How does functional constipation affect growth status in children?

In terms of growth status, the average weight of children in groups with and without constipation was 23.69 ± 4.14 kg and 31.62 ± 4.85 kg, respectively, which demonstrates a significant lower weight in the group with constipation (P < 0.001).

When should constipation in children be considered functional constipation?

The term 'functional constipation' describes all children in whom constipation does not have an organic etiology . Functional constipation is commonly the result of withholding of feces in a child who wants to avoid painful defecation.

How do you treat functional constipation?

Doctors often recommend laxatives to treat functional constipation. Increasing your fiber intake and exercising regularly may also help reduce your symptoms.

How do you manage functional constipation?

Treatment of functional constipation involves disimpaction using oral or rectal medication . Polyethylene glycol is effective and well tolerated, but a number of alternatives are available. After disimpaction, a maintenance program may be required for months to years because relapse of functional constipation is common.

What is the long term treatment of functional constipation?

Guanylate cyclase-C agonists are also used for patients with chronic idiopathic constipation. These medications, which include linaclotide (Linzess) and plecanatide (Trulance), help make you more regular. They can lessen the pain in your abdomen and make bowel movements happen more often.

Can functional constipation be cured?

Still, your stool may be hard and difficult to pass. You may have belly pain or bloating, too. It usually gets better by eating more fiber-rich foods or by using a certain kind of laxative. Slow transit constipation: This means your colon isn't moving waste fast enough.

What is the number one cause of chronic constipation?

It happens most often due to changes in diet or routine , or due to inadequate intake of fiber. You should call a healthcare provider if you have severe pain, blood in your stool or constipation that lasts longer than three weeks.

What medication is used for functional constipation?

For chronic use, bulk laxatives (fiber) and polyethylene glycol 3350 (“PEG,” e.g., Miralax) are tolerated best. Bulk laxatives include psyllium (Metamucil) and methylcellulose (Citrucel). Stimulant laxatives like senna and bisacodyl (Dulcolax) can produce excessive cramping and should therefore be used sparingly.

What are the symptoms of functional constipation in children?

Two or fewer defecations in the toilet per week in a child of a developmental age of at least 4 years . At least 1 episode of fecal incontinence per week. History of retentive posturing or excessive volitional stool retention. History of painful or hard bowel movements.

What is functional constipation about kids health?

Functional constipation is not a result of a medical problem . It happens when a child withholds stool, usually because they are afraid of the pain linked to passing hard stools or have a fear of the toilet.

Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. (2024)

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Health Technol Assess. 2024 Jan; 28(5): 1–266.

doi:10.3310/PLTR9622

PMCID: PMC11017632

PMID: 38343084

Alex Todhunter-Brown, Lorna Booth, Pauline Campbell, Brenda Cheer, Julie Cowie, Andrew Elders, Suzanne Hagen, Karen Jankulak, Helen Mason, Clare Millington, Margaret Ogden, Charlotte Paterson, Davina Richardson, Debs Smith, Jonathan Sutcliffe, Katie Thomson, Claire Torrens, and Doreen McClurg

Abstract

BACKGROUND

Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear.

OBJECTIVE

To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented.

METHODS

Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains.

RESULTS

Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps.

SCOPING REVIEW

651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations.

EFFECTIVENESS SYSTEMATIC REVIEWS

studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators.

CONCLUSIONS

Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42019159008.

FUNDING

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.

Plain language summary

Between 5% and 30% of children experience constipation at some stage. In one-third of these children, this progresses to chronic functional constipation. Chronic functional constipation affects more children with additional needs. We aimed to find and bring together published information about treatments for chronic functional constipation, to help establish best treatments and treatment combinations. We did not cover assessment or diagnosis of chronic functional constipation. This project was guided by a ‘stakeholder group’, including parents of children with constipation, people who experienced constipation as children, and healthcare professionals/continence experts. We carried out a ‘scoping review’ and a series of ‘systematic reviews’. Our ‘scoping review’ provides an overall picture of research about treatments, with 651 studies describing 48 treatments. This helps identify important evidence gaps. ‘Systematic reviews’ are robust methods of bringing together and interpreting research evidence. Our stakeholder group decided to structure our systematic reviews to reflect who delivered the interventions. We brought together evidence about how well treatments worked when delivered by families/carers (32 studies), the wider children’s workforce (e.g. general practitioner, health visitor) (21 studies), continence teams (31 studies) or specialist consultant-led teams (42 studies). We also considered complementary therapies (15 studies) and behavioural strategies (4 studies). Care is affected by what is done and how it is done. We brought together evidence about different models of delivering care (15 studies), barriers and facilitators to implementation of treatments (106 studies) and costs (31 studies). Quality of evidence was mainly low to very low. Despite numerous studies, there was often insufficient information to support generalisable conclusions. Our findings generally agreed with current clinical guidelines. Management of childhood chronic functional constipation should be child-centred, multifaceted and adapted according to the individual child, their needs, the situation in which they live and the health-care setting in which they are looked after. Research is needed to address our identified evidence gaps.

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