This document defines and discusses constipation. It defines functional constipation using the Rome 3 criteria as having two or fewer bowel movements per week and other symptoms, in the absence of organic pathology. Causes of constipation include anatomic abnormalities, intestinal muscle/nerve disorders, metabolic disorders, drugs, and intestinal disorders. Red flags signs include fever, vomiting, bloody diarrhea, failure to thrive, and anal abnormalities. Treatment involves disimpacting the bowels using polyethylene glycol or enemas, then maintaining regularity through diet, toilet training, and laxatives as needed. Follow up is recommended monthly until regularity is achieved, then every 3 months for 2 years and yearly thereafter.

1. CONSTIPATION
-DR. SUMEET BAHETI
-DR. LEENA VYASVANI

2. DEFINITION
• ROME 3 CRITERIA: Functional
Constipation
>=2 of the following
1. 2 or less defecations per wek
2. One episode of fecal incontinence per
week
3. History of retentive posture or stool
withholding maneuver
4. history of painful or hard bowel
movement
5. presence of large fecal mass in the
rectum
6. history of large-diameter stools that
may obstruct the toilet
• And
• Absence of any organic pathology
• With duration of atleast 1 month in
<4year of age and atleast 2 months in
>4year of age

3. ETIOLOGY- FUNCTIONAL CAUSES
CAUSES
ANATOMIC
-ANAL
ABNORMAL
MUSCULATURE
-DOWNS
-GASTROCHISIS
-PRUNE BELLY
SYNDROME
INTESTINAL
MUSCLE/NERVE
SPINE/INTESTINE
DRUGS
METABOLIC
DISORDERS
K/CA/THY/DM
INTESTINAL
DISORDERS
CELIAC/CTD/SLE

4. Pathogenesis

5. RED FLAG SIGNS
• Fever
• Vomiting
• Bloody diarrhoea
• Failure to thrive
• Anal stenosis
• Tight empty rectum
• Absent anal wink and cremastric reflex
• Flat buttock
• Lack of lumbo-sacral curve
• Sacral agenesis
• Anteriorly displaced anus

6. Approach

7. • Fecal impaction- This can be accomplished by abdominal examination (in half of the cases
hard fecal mass or fecalith is palpable in the lower abdomen), by digital rectal examination
(rectum is usually loaded with hard stools), or rarely by abdominal X-ray.
• Fecal Disimpaction-
-ORAL: Polyethylene glycol (PEG) lavage solution is given orally (1-1.5g/kg/day for 3-6 days) or by
naso-gastric tube (25mL/kg/hour, reconstituted PEG solution) until clear fluid is excreted through
anus.
-RECTAL: if PEG is not available then enema can be used for disimpaction (sodium phosphate
enema [proctoclysis]: 2.5 mL/kg, maximum 133ml/dose for 3-6 days)

8. Maintainence therapy
• Dietary Modification: more fluids, absorbable and non- absorbable
carbohydrate fruit juices like apple, pear and prune juices. The
recommended daily fiber intake is age (in years) + 5 in g/day. Restrict
milk.
• Toilet training.
• Maintain a daily record (stool diary) of bowel movements, fecal
soiling, pain or discomfort, consistency of stool and the laxative dose.
• Follow up: monthly till regular bowel movements achieved, 3
monthly for 2 years, then yearly

9. DRUGS

10. THANK YOU