Clinico-etiological spectrum of constipation in children


  • Shipra Sharma Department of Surgery, Pt. JNM Medical College, Raipur, Chhattisgarh, India
  • Sukhlal Nirala Department of Surgery, Pt. JNM Medical College, Raipur, Chhattisgarh, India
  • Rajendra Ratre Department of Surgery, Pt. JNM Medical College, Raipur, Chhattisgarh, India



Constipation, Children, Functional, Organic


Background: Childhood constipation is a common problem that has been difficult to define because it may comprise of diverse symptoms, from delay or difficulty in defecation sufficient to cause significant distress, to symptoms of faecal incontinence, displaying of retentive posturing and withholding behaviour to painful defecation and passing of stools so large that they may obstruct the toilet. Knowledge of common etiology of constipation and characteristic presentation may help us in initial management of patient without subjecting them to armour of investigation.

Methods: The prospective interventional analytical study conducted in the Department of Surgery and Department of Pediatrics Pt. J.N.M. Medical College and Dr. B.R.A.M Hospital, Raipur (Chhattisgarh), India. Consecutive 81 children with constipation presenting to OPD of pediatrics and pediatric surgery at Dr B.R.A.M Hospital, Raipur (Chhattisgarh), India between January 2010 to January 2011 were included in the study.

Results: Mean age at presentation was found overall to be 54.49±10.85 months. Presentation of constipation in boys and girls (44% vs 56% in functional and 54% vs 46% in organic). Of the organic causes Hirschsprung’s disease was the commonest diagnosis made (63%). Other organic causes were Rectal stenosis with anteriorly placed anal canal (1.2%), rectal prolapsed (1.2%), anal fissure (1.2%) and associated with dysgerminoma in pelvic cavity in one case.

Conclusions: Assessment and management of pediatric constipation poses many challenges for the practitioner including deciphering whether the problem is organic or non-organic in nature.


Levine MD, Bakow H. Children with encopresis: a study of treatment outcome. Pediatr. 1976;58(6):845-52.

Loening-Baucke V. Modulation of abnormal defecation dynamics by biofeedback treatment in chronically constipated children with encopresis. J Pediatr. 1990;116(2):214-22.

Partin JC, Hamill SK, Fischel JE, Partin JS. Painful defecation and fecal soiling in children. Pediatr. 1992;89(6):1007-9.

Voskuijl WP, Heijmans J, Heijmans HS, Taminiau JA, Benninga MA. Use of Rome II criteria in childhood defecation disorders: applicability in clinical and research practice. J Pediatr. 2004;145(2):213-7.

Khanna V, Poddar U, Yachha SK. Etiology and clinical spectrum of constipation in Indian children. Indian Pediatr. 2010;47(12):1025-30.

Loening-Baucke V. Constipation in early childhood: patient characteristics, treatment, and longterm follow up. Gut. 1993;34(10):1400-4.

van den Berg MM, Dijkgraaf MG, van Wijk MP, Bongers ME, Liem O, Benninga MA. Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG. Pediatr. 2009;124(6):e1108-15.

Poenaru D, Roblin N, Bird M, Duce S, Groll A, Pietak D, et al. The pediatric bowel management clinic: initial results of a multidisciplinary approach to functional constipation in children. J Pediatr Surg. 1997;32(6):843-8.

Blum NJ, Taubman B, Nemeth N. Relationship between age at initiation of toilet training and duration of training: a prospective study. Pediatr. 2003;111(4):810-4.

Croffie JM. Constipation in children. Ind J Pediatr. 2006;73(8):697-701

Rubin G, Dale A. Chronic constipation in children. Bmj. 2006;333(7577):1051-5.

Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatr. 1997;100(2):228-32.

Naspghan C. Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43(3):1-3.

Croffie JMB, Fitzgerald JF. Idiopathic constipation. In: Pediatric Gastrointestinal Disease. Walker WA, Goulet O, Kleinman RE, BC Decker Inc. 4th edition. Ontario; 2004:1001.

Abrahamian FP, Lloyd-Still JD. Chronic constipation in childhood: a longitudinal study of 186 patients. J Pediatr Gastroenterol Nutri. 1984;3(3):460-7.

Boccia G, Manguso F, Coccorullo P, Masi P, Pensabene L, Staiano A. Functional defecation disorders in children: PACCT criteria versus Rome II criteria. J Pediatr. 2007;151(4):394-8.

Burnett CA, Juszczak E, Sullivan PB. Nurse management of intractable functional constipation: a randomised controlled trial. Archi Dis Childhood. 2004;89(8):717-22.

Imseis E, Gariepy CE. Hirschsprung Disease. In: Walker WA, Goulet O, Kleinman RE, ShermanPM, Shneider BL, Sanderson IR (Eds). Pediatric Gastrointestinal Disease. Hamilton, Ontario: BCDecker Inc; 2004: 1031-1043.

Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr. 2005;146(3):359-63.

Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterol. 2006;130(5):1527-37.

Taubman B. Toilet training and toileting refusal for stool only: a prospective study. Pediatr. 1997;99(1):54-8.






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