Constipation is one of the problems that pediatricians and pediatric surgeons encounter quite frequently. Constipation is the condition of hard and infrequent defecation as a result of inability or insufficient defecation. Another definition is defecation less than 3 times a week, hard mass, painful defecation, and optional stool retention. While defining, stool consistency and water content percentage of stool are more important than the number of defecations. Constipation may be short-lived and temporary, or it may be chronic. Constipation that lasts longer than one month is considered chronic constipation. Chronic constipation can raise concerns for families that it may be a symptom of a serious illness.
Constipation is of organic or functional cause. Constipation in a very small proportion of children is due to organic causes. The most common cause of constipation (90-95%) after the neonatal period is functional constipation. Functional constipation is also called “idiopathic (unknown cause) constipation”, “fecal retention” and “fecal withholding”. Many times, constipation can be the cause of chronic constipation if not treated well or treated incorrectly. Functional constipation is the cause in approximately 96% of children with constipation. While the treatment of organic constipation is mostly surgical, medical treatment is often sufficient in children with functional constipation. The general approach in the treatment of a case with functional constipation is to first determine whether there are fecal deposits. If there is fecaloma, fecal evacuation treatment can be given, or in cases where it is not possible to start with medication, fecalomas may need to be evacuated by rectal touching in the office or operating room conditions. In order to prevent the formation of fecaloma and to ensure regular defecation, it is necessary to initiate maintenance therapy, to provide family education, and to continue the treatment regularly with close monitoring. Constipation treatment is long-term. Generally, follow-up and treatment of patients for 6-24 months is recommended.
