Davina Richardson, Specialist Children’s Nurse, (Bladder & Bowel UK)
With the taboos associated with discussing elimination, many parents do not know what is normal with respect to bowel motions in childhood. Not only is constipation poorly understood by families, but also by many healthcare professionals who are rarely offered education on a condition that can be difficult to diagnose, and which has a pooled prevalence of 9.5%1. This results in under-estimation of its impact by some2 and childhood constipation being the cause of many enquires to the Bladder & Bowel UK helpline.
Childhood constipation requires prompt and proactive treatment with laxatives alongside optimisation of diet and fluids and toileting programmes to increase likelihood of resolution. However, Bongers et al3 found that 25% of affected children continued to have symptoms into adulthood, with factors increasing the likelihood of its persistence including delay between symptom onset and presentation to a specialist clinic and restricted laxative use.
Treatment should always commence with oral laxatives2. The next step in the treatment ladder should be rectal preparations, such as suppositories or mini enemas. If constipation remains intractable, rectal irrigation is usually the option considered next and has been demonstrated to be successful for children with functional constipation4.
Bladder & Bowel UK continue to offer support to families affected by childhood constipation, providing information on their website and support via the helpline. They also offer training to healthcare professionals about assessment and management of this common, but distressing condition. For more information visit www.bbuk.org.uk.
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1 Koppen IJN et al (2018) Prevalence of Functional Defecation Disorders in Children: A systematic review and meta-analysis. The Journal of paediatrics 198: pages 121-130
2 NICE (2010) Constipation in children and young people: diagnosis and management. Clinical guideline [CG99] https://www.nice.org.uk/guidance/cg99/chapter/Introduction
3 Bongers MEJ et al (2010) Long-term prognosis for childhood constipation: clinical outcomes in adulthood. Paediatrics 126 e156-e162
4 Jorgensen CS et al (2017) Transanal irrigation is effective in functional faecal incontinence. European Journal of Paediatrics DOI:10.1007/s00431-017-2902-3