Management of chronic functional constipation in children – a review of the literature

Background Constipation in childhood is relatively common. For some children, constipation can become a chronic problem, with a significant psychosocial impact on children and their families. It has been estimated that chronic constipation accounts for around 3% of out-patient visits with a paediatrician and approximately 25% of visits to a paediatric gastroenterologist. The prevalence appears to be rising. Aim To review the literature with respect to assessment and management of chronic functional constipation in children. Design Literature review. Methods A search of medical, nursing and allied health electronic databases for literature published between 1980 and 2009 in order to provide a current definition, causes, assessment, management and treatment outcomes for chronic functional constipation in children. Results No studies were found that identified a definitive solution to management; however, there is documented consensus on definitions and terminology and the most effective approaches to manage chronic functional constipation in childhood. Conclusion Initial assessment is essential to ascertain the child and family's understanding of constipation and any previous history of treatment. The main foci for management include disimpaction of faeces with lavage solutions and/or enemas; maintenance therapy with laxatives to keep the rectum empty; education and behavioural therapy; and regular follow-up to support the child and family to maintain regular bowel habits and toileting. Implications for clinical practice This review will help guide and inform clinical practice in relation to assessment and management of chronic functional constipation in children and enable the development of tools and care plans.