Clinical Review

Childhood constipation

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7309 (Published 13 November 2012) Cite this as: BMJ 2012;345:e7309
  1. Marcus K H Auth, consultant paediatric gastroenterologist,
  2. Rakesh Vora, specialist registrar in paediatric gastroenterology,
  3. Paul Farrelly, specialist registrar in paediatric surgery,
  4. Colin Baillie, consultant paediatric general surgeon
  1. 1Departments of Paediatric Gastroenterology and General Surgery, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
  1. Correspondence to: M K H Auth marcus.auth{at}alderhey.nhs.uk

Summary points

  • Childhood constipation is common and often associated with faecal incontinence

  • An essential aim is to prevent pain associated with defecation

  • Invasive investigations are not routinely needed for diagnosis

  • Indications for referral are signs of organic disease and review of treatment

  • Chronicity can be debilitating and has behavioural and social consequences

  • The lack of evidence on causes and treatment suggests that more research is needed

Constipation is common in children, affecting between 5% (longer duration) and 30% (duration less than six months) of school aged children in the United Kingdom.1 2 It accounts for 3% of general paediatric consultations and 25-30% of consultations with paediatric gastroenterologists.1 2 Symptoms at presentation are variable, and the condition has often progressed to cause substantial discomfort, pain, and secondary effects, which require efficient and prolonged treatment.

Successful management depends on recognising common causes and excluding rare ones; explaining the functional causes, clinical diagnosis, and treatment principles to the patient and family; individual tailoring of treatment; achieving adherence; and providing personalised continuity of care. Because evidence for pathogenesis and treatment is limited, this review summarises current evidence and aims to provide practical advice in primary care.

Sources and selection criteria

We searched the Clinical Evidence Database and Cochrane Database of Systematic Reviews. We also consulted National Institute for Health and Clinical Excellence (NICE) clinical guidance 99 (updated June 2012). PubMed was used to identify peer reviewed original articles, meta-analyses, and reviews written in English, mainly published during the past 15 years, or earlier pioneering works. Empirical data are provided when evidence is lacking.

What is childhood constipation?

The term constipation describes a collection of symptoms rather than a specific disease in childhood. Diagnosis therefore relies on the reported symptoms, accurate description of bowel habits, interpretation, and examination.2 An international group has classified constipation among the spectrum of functional bowel disorders and …

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