The management of chronic constipation

Chronic constipation is a common problem in childhood. A minority of cases are due to an underlying organic cause and such cases can usually be identified through a thorough history and examination, with focused investigations. Constipation can have a significant impact on the social and emotional development of a child, as well as affecting the family dynamics. It is important to take these factors into consideration when assessing and treating a child and a multidisciplinary approach to care has been shown to be the most effective. Although there is a general consensus regarding the principles of treatment, the evidence behind the choice of laxative is still lacking. Effective treatment requires the disimpaction of retained stool followed by re-establishment of a regular bowel habit. Whilst approximately 70% of children will become symptom free off all medication, a significant cohort continues to have symptoms despite a prolonged period of treatment.