Case history
Case history #1
A 5-month-old baby boy presents with difficulty and delay in passing hard stools. His mother reports that he strains for several hours and may even miss a day, before passing stool with screaming and occasional spots of fresh blood on the stool or diaper. He has recently been weaned from breastfeeding to cows' milk formula, which he had been reluctant to drink initially. The child is thriving and now feeding normally. There was no neonatal delay in defecation and no history of excessive vomiting or abdominal distention.
Case history #2
A 14-year-old girl, concerned about body image, altered her diet and decreased her oral intake hoping to lose weight. Additionally, she avoided restrooms at school due to their lack of cleanliness. She presented to her pediatrician with the complaint of abdominal pain, distention, bloating, and difficult, painful defecation.
Other presentations
In 90% to 95% of children with constipation, the problem is functional.[1] However, organic causes should be considered in making this diagnosis. Chronic constipation may present after any cause of painful defecation such as an anal fissure; perianal streptococcal infection; food intolerance (particularly cows' milk allergy); lichen sclerosus; and penetrative child sexual abuse. Refusal to defecate may also be a presentation of complex psychological problems, such as communication disorders that fall within the autistic spectrum or children with attention deficit disorder.[2][3] Fecal incontinence in later childhood may occur after poor sensory or behavioral response to fecal loading of the rectum secondary to longstanding megarectum. Rarer causes of constipation include those presenting in the first weeks of life, such as Hirschsprung disease or anorectal anomalies. In teenage years, abnormal diets as well as eating disorders may lead to constipation.
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