[Guidelines for diagnosis and treatment of constipation in Mexico. D) Evaluation and treatment of constipation in pediatric population]

José María Remes Troche, José Antonio Chávez Barrera, Beatriz González Ortíz, Solange Heller Rouassant, Ericka Montijo Barrios, María del Rosario Velasco Lavín, Liliana Beatriz Worona Dibner
Revista de Gastroenterología de México 2011, 76 (2): 155-68

BACKGROUND: Constipation is one of the most common causes of consultation in pediatric practice, it has a multifactorial etiology and its treatment can be complex.

OBJECTIVES AND METHODS: To establish the clinical guidelines for diagnosis and treatment of chronic constipation in pediatric population in Mexico, a review of the epidemiological, diagnostic and therapeutic aspects was conducted by an expert group of pediatric gastroenterologist in our country.

RESULTS: Constipation is a symptom that reflects the presence of fecal retention, which is reported by patients or their relatives as decreased stool frequency, hard stools, and sometimes pain and excessive pushing. Constipation can occur at any stage of childhood. The main trigger for fecal retention is the painful evacuation. Patients who meet the Rome III criteria for functional constipation do not require diagnostic tests. The diagnostic tests are reserved for cases in which alarm signs are present and in patients refractory to conventional treatment. The goal of treatment is to promote smooth and painless evacuations preventing reaccumulation of stool. Osmotic laxatives such as polyethylene glycol and lactulose are the most effective treatments. In special cases, biofeedback therapy, the use of botulinum toxin and surgery can be effective, although the evidence is weak.

CONCLUSIONS: Management of chronic constipation in pediatric population requires a comprehensive diagnostic approach.

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