InnovAiT, 0(0), 1–9 Childhood constipation Dr Syukri Rahim Keele University, Staffordshire Audley Health Centre, Stoke-on-Trent, Staffordshire Email: Awangku.pengriran@uhnm.nhs.uk C onstipation is a common problem in childhood. It is often under-reported and families may delay seeking help due to fear of embarrassment and a negative response from healthcare professionals. Healthcare professionals may also underestimate the impact of constipation on the child and their family and this may subsequently contribute to poor clinical outcomes. Although it is rarely life-threatening, many children and young people experience psychological, social and educational consequences that require prolonged support. Signs and symptoms of childhood constipation are often poorly recognised. Delayed diagnosis, suboptimal therapy and lack of understanding of the condition often contribute to the ongoing symptoms and multiple medical consultations. Definition and terminology The term constipation describes a collection of symptoms rather than a specific childhood disease, and diagnosis there- fore relies on accurate description of the bowel habits, reported symptoms and physical examination findings. Definition usually includes decreased defecation frequency, occurrence of stool retention (faecal impaction), faecal incon- tinence (encopresis, soiling), passage of hard or painful bowel movements (Auth et al., 2012). There have been attempts to define diagnostic criteria and terms more precisely. At present, the Rome III criteria are the most widely cited definitions used for childhood functional constipation. The definitions are divided into two groups, based on the age of the child (see Box 1). The term idiopathic or functional constipation is used when the constipation cannot be explained by any underlying ana- tomical, physiological, histological or radiological abnormality. Constipation is considered chronic when it lasts longer than 8 weeks. The term ‘intractable constipation’ may be used when the constipation has not responded to optimal conven- tional therapy for at least 3 months. Faecal impaction is defined as a severe constipation with a large hard stool in the abdomen or rectum and/or overflow soiling (National Collaborating Centre for Women’s and Children’s Health (UK), 2010; Tabbers et al., 2014). Normal patterns of defecation The number of bowel movements depends on the child’s age. It decreases with age and reaches adult frequencies in the Box 1. Rome III diagnostic definitions for functional constipation. In the absence of an organic pathology, two or more of the following must occur: For a child with a developmental age less than 4 years (criteria fulfilled for at least 1 month): . Two or less defaecations per week . At least one episode of incontinence per week after acquiring toilet skills . History of excessive stool retention . Presence of large faecal mass in the rectum . History of large stools that may obstruct the toilet . History of painful or hard bowel movements For a child with a developmental age more than 4 years with insufficient criteria for irritable bowel syndrome (cri- teria fulfilled for at least 2 months): . Two or less defaecations in the toilet per week . At least one episode of incontinence per week . History of retentive posturing or excessive volitional stool retention . Presence of large faecal mass in the rectum . History of painful or hard bowel movements . History of large stools that may obstruct the toilet Source: Hyman et al. (2006) and Rasquin-Weber et al. (2006). InnovAiT, 2019, Vol. 0(0), 1–9, ! The Author(s) 2019. Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1755738019867995 1 journals.sagepub.com/home/ino