Abstract
The effective management of constipation in childhood requires an understanding of the ways that the physical and psychological factors interact. The early difficulty with defecation that leads to pain, fear, and refusal to use the pot or lavatory often progresses to the formation of vicious cycles of increasing faecal retention as the rectum increases in capacity and the experience of passing large, hard stools is repeated. There is increasing distress as overflow faecal incontinence compounds the problem for the older child. The medical, psychological, and surgical management strategies are reviewed together with the rationale for their use.
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Selected References
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- CALLAGHAN R. P., NIXON H. H. MEGARECTUM: PHYSIOLOGICAL OBSERVATIONS. Arch Dis Child. 1964 Apr;39:153–157. doi: 10.1136/adc.39.204.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cheu H. W., Grosfeld J. L. The atonic baggy rectum: a cause of intractable obstipation after imperforate anus repair. J Pediatr Surg. 1992 Aug;27(8):1071–1074. doi: 10.1016/0022-3468(92)90562-l. [DOI] [PubMed] [Google Scholar]
- Fitzgerald J. F. Constipation in children. Pediatr Rev. 1987 Apr;8(10):299–302. doi: 10.1542/pir.8-10-299. [DOI] [PubMed] [Google Scholar]
- Freeman N. V. Intractable constipation in children treated by forceful anal stretch or anorectal myectomy: preliminary communication. J R Soc Med. 1984;77 (Suppl 3):6–8. [PMC free article] [PubMed] [Google Scholar]
- Ghosh A., Griffiths D. M. Rectal biopsy in the investigation of constipation. Arch Dis Child. 1998 Sep;79(3):266–268. doi: 10.1136/adc.79.3.266. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hall David. Child protection--lessons from Victoria Climbié. BMJ. 2003 Feb 8;326(7384):293–294. doi: 10.1136/bmj.326.7384.293. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Krishnamurthy S., Heng Y., Schuffler M. D. Chronic intestinal pseudo-obstruction in infants and children caused by diverse abnormalities of the myenteric plexus. Gastroenterology. 1993 May;104(5):1398–1408. doi: 10.1016/0016-5085(93)90348-g. [DOI] [PubMed] [Google Scholar]
- Lee Steven L., DuBois Jeffrey J., Montes-Garces Ramon G., Inglis Kristen, Biediger William. Surgical management of chronic unremitting constipation and fecal incontinence associated with megarectum: A preliminary report. J Pediatr Surg. 2002 Jan;37(1):76–79. doi: 10.1053/jpsu.2002.29431. [DOI] [PubMed] [Google Scholar]
- Loening-Baucke V. Constipation in early childhood: patient characteristics, treatment, and longterm follow up. Gut. 1993 Oct;34(10):1400–1404. doi: 10.1136/gut.34.10.1400. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Malone P. S., Ransley P. G., Kiely E. M. Preliminary report: the antegrade continence enema. Lancet. 1990 Nov 17;336(8725):1217–1218. doi: 10.1016/0140-6736(90)92834-5. [DOI] [PubMed] [Google Scholar]
- Navarro J., Sonsino E., Boige N., Nabarra B., Ferkadji L., Mashako L. M., Cezard J. P. Visceral neuropathies responsible for chronic intestinal pseudo-obstruction syndrome in pediatric practice: analysis of 26 cases. J Pediatr Gastroenterol Nutr. 1990 Aug;11(2):179–195. doi: 10.1097/00005176-199008000-00006. [DOI] [PubMed] [Google Scholar]
- PORTER N. H. A physiological study of the pelvic floor in rectal prolapse. Ann R Coll Surg Engl. 1962 Dec;31:379–404. [PMC free article] [PubMed] [Google Scholar]
- Powell Catherine. Lessons to be learnt from the Victoria Climbié inquiry. Br J Nurs. 2003 Feb 13;12(3):137–137. doi: 10.12968/bjon.2003.12.3.137. [DOI] [PubMed] [Google Scholar]
- Roy A. D., Bharucha H., Nevin N. C., Odling-Smee G. W. Idiopathic intestinal pseudo-obstruction: a familial visceral neuropathy. Clin Genet. 1980 Oct;18(4):291–297. doi: 10.1111/j.1399-0004.1980.tb00888.x. [DOI] [PubMed] [Google Scholar]
- Schuffler M. D., Bird T. D., Sumi S. M., Cook A. A familial neuronal disease presenting as intestinal pseudoobstruction. Gastroenterology. 1978 Nov;75(5):889–898. [PubMed] [Google Scholar]
- Speakman C. T., Burnett S. J., Kamm M. A., Bartram C. I. Sphincter injury after anal dilatation demonstrated by anal endosonography. Br J Surg. 1991 Dec;78(12):1429–1430. doi: 10.1002/bjs.1800781206. [DOI] [PubMed] [Google Scholar]
- Talley N. J., Weaver A. L., Zinsmeister A. R., Melton L. J., 3rd Functional constipation and outlet delay: a population-based study. Gastroenterology. 1993 Sep;105(3):781–790. doi: 10.1016/0016-5085(93)90896-k. [DOI] [PubMed] [Google Scholar]