Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- difficult or painful defecation
- long interval between stools
- faecal incontinence
- small-volume, soft, incontinent stool
- palpable faecal mass per abdomen
- otherwise healthy child
Other diagnostic factors
- abdominal pain
- abdominal distention
- anal fissure
- associated bladder problems
- abnormal anal appearance
Risk factors
- low-fibre diet
- poor-nutrient diet
- genetic predisposition
- infection
- stress
- obesity
- low birth weight
- psychiatric history
- physical disability
- poor toilet training
- immune dysregulation
- low fluid intake
- trauma
Diagnostic investigations
Investigations to consider
- abdominal x-ray
- radiopaque marker colonic transit study
- abdominal ultrasound
- contrast enema
- rectal suction biopsy
- psychological assessment
Treatment algorithm
Contributors
Authors
Jaime Belkind-Gerson, MD, MSc
Director Neurogastroenterology and Motility Program
Digestive Health Institute
Children's Hospital Colorado
Associate Professor of Pediatrics
University of Colorado School of Medicine
Colorado
CO
Disclosures
JB-G declares that he has no competing interests.
Claire Zar-Kessler, MD
Instructor in Pediatric Gastroenterology
Massachusetts General Hospital for Children
Boston
MA
Disclosures
CZ-K has received support from Takeda for a clinical trial on prucalopride.
Acknowledgements
Dr Jaime Belkind-Gerson and Dr Claire Zar-Kessler would like to gratefully acknowledge Dr Corey Baker, Dr Wael El-Matary, Dr Steffen Reinsch, and Dr Meghan McPherson, the previous contributors to this topic.
Disclosures
CB, WE-M, SR, and MM declare that they have no competing interests.
Peer reviewers
David C.A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU
Consultant Paediatric Gastroenterologist
Royal West Sussex NHS Trust
Chichester
UK
Disclosures
DCAC has served as a consultant to, and spoken at symposia sponsored by, Norgine Ltd.
Vikram Boolchand, MD
Gastroenterology Fellow
University of Arizona
Tucson
AZ
Disclosures
VB declares that he has no competing interests.
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
Disclosures
DJH declares that he has no competing interests.
Use of this content is subject to our disclaimer