Evaluation and Management of Intractable Constipation in Children

Constipation is a common problem in the pediatric age group and accounts for approximately 5% of visits to pediatricians’ offices. More severe forms of constipation are seen in a smaller percentage of children, and these young patients are often referred to a pediatric gastroenterologist for continued management. Despite the use of laxatives, stool softeners, behavioral modification, and diet management, a small percentage of that group develops debilitating symptoms that can be associated with severe intractable constipation. In this select group, constipation becomes an overriding problem interfering with the normal activities of daily living as well as impacting negatively on the child’s quality of life and the home environment. In this group, missed days of school, social stigma, and frequent visits to the pediatrician’s or pediatric gastroenterologist’s office identify those children as patients who need additional investigations and possible surgery. A sequential evaluation of the child with severe refractory constipation will identify a small but substantial number of children who will benefit by additional surgical intervention.