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Key Features

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  • Defined as the repeated passage of stool into inappropriate places (such as in the underpants) by child who is chronologically or developmentally older than 4 years

  • Occurs each month for at least 3 months and is not attributable to the physiologic effects of a substance or another medical condition except to the mechanism involving constipation

  • Prevalence at highest between 5 and 6 years of age

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Clinical Findings

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  • Constipation is defined by two or more of the following events for 2 months

    • Fewer than three bowel movements per week

    • More than one episode of encopresis per week

    • Impaction of the rectum with stool

    • Passage of stool so large that it obstructs the toilet

    • Retentive posturing and fecal withholding

    • Pain with defecation

  • Conditions associated with constipation include

    • Metabolic disorders such as hypothyroidism

    • Neurologic disorders such as cerebral palsy or tethered cord,

    • Anatomic abnormalities of the anus

    • Stress or maltreatment

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Diagnosis

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  • A complete history and meticulous physical examination must be performed, including a rectal examination, particularly looking for abnormalities around the anus and spine

  • An abdominal radiograph can be helpful in determining the degree of constipation, the appearance of the bowel, and whether there is obstruction

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Treatment

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  • Initial intervention starts with treatment of constipation

  • Subsequently, education, support, and guidance around evacuation are essential

  • If there is an underlying psychiatric disorder, such as depression, the child should be treated for the mental health problem as well as constipation

  • When medical management of constipation is indicated, oral medication or an enema for "bowel cleanout" followed by oral medications should be used

  • Child should be encouraged to have a daily bowel movement, and the use of fiber, some laxatives, and even mineral oil can be helpful

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