Evaluation and Management of Intractable Constipation in Children

Intractable constipation has a negative impact on quality of life and well-being of children. The evaluation includes a thorough history and physical examination with diagnostic testing to rule out metabolic, systemic, anatomic, and neurological etiologies. In children with refractory symptomswhofailed aggressive medical management, colonic transit studies help guide need for invasive testing. Manometric testing of the anorectum and the colon are recommended to evaluate for enteric neuromuscular compromise and guide novel medical and surgical therapies. Goals of management are to facilitate colonic emptying, ensure fecal continence, and preserve colonic neuromuscular integrity. Treatments range from aggressive medical therapy with stimulant laxatives that modify transit to antegrade continence enemas that facilitate colonic emptying. Surgery, including diverting ostomy and resection, has a limited role and should only be considered in select patients after medical and manometric evaluation. The aim of this article is to provide an update on the evaluation and management of childhood intractable constipation.