Constipation is a common problem in childhood and is usually functional, often involving stool withholding. Successful management requires parent education, behavioural strategies, laxatives (often long term) and ongoing review.
Constipation affects up to 30% of children, and peak incidence is at the time of toilet training.1-3
Constipation is defined by the frequency of stooling (fewer than two per week in children over 4 years of age), but more importantly by stool consistency and difficulty with which stools are passed (Case Study 1, Box 1).
Constipation arising beyond the neonatal period is usually functional constipation; this diagnosis can be made clinically after a careful history and physical examination, looking for red flags that may suggest organic pathology.
Faecal incontinence (encopresis) develops in up to 50% of children with chronic untreated constipation and has a significant psychosocial impact.4
Management of constipation is often a long-term process that requires the complementary approaches of careful education of the child and parents, behavioural techniques, laxative agents and review.