REVISTA ROMÂNÅ DE PEDIATRIE – VOLUMUL LXIV, NR. 1, AN 2015 14 GENERAL PAPERS Corresponding author: Smaranda Diaconescu, „Gr. T. Popa“ University of Medicine and Pharmacy, 16 University Street, Iasi E-mail: turti23@yahoo.com MULTIDISCIPLINARY APPROACH TO CHRONIC CONSTIPATION ASSOCIATED WITH FECAL INCONTINENCE IN CHILDREN Claudia Olaru 1 , Smaranda Diaconescu 1 , Valeriu V. Lupu 1 , Nicoleta Gimiga 1 , Gabriela Paduraru 1 , Ancuta Ignat 1 , Radian A. Olaru 2 , Vasile Drug 3 , Marin Burlea 1 1 Department of Pediatrics, „Sf. Maria“ Children Emergency Hospital, „Gr. T. Popa“ University of Medicine and Pharmacy, Iasi 2 „Gr. T. Popa“ University of Medicine and Pharmacy, Iasi 3 Institute of Gastroenterology and Hepatology, „Gr. T. Popa“ University of Medicine and Pharmacy, Iasi ABSTRACT Constipation is a common symptom in clinical practice. Definition include abnormal transit difficulty during def- ecation and abnormal stool consistency. Limited diagnostic methods and the many diseases that lead to symp- toms, leading to more cases of drug resistance. Treatment includes dietary and behavioral approaches, phar- macological therapy and surgery in carefully selected cases. Surgery is recommended in patients with severe constipation resistant to conservative treatment. Confirmation of indication for surgical treatment requires co- lonic transit studies, defecation function and conducting anorectal manometry. Therefore, a close collaboration between pediatric gastroenterologists and surgeon pediatricians is essential for the careful preoperative evalu- ation and gastrointestinal function. Postoperative complications include intestinal obstruction, abdominal pain, flatulence and diarrhea. The effectiveness of surgery and prevalence of postoperative complications are deter- mined by a careful preoperative evaluation of the gastrointestinal function. Keywords: organic constipation, encomprezis, surgical treatment, child Chronic constipation is a debilitating disease that is best managed through a multidisciplinary approach that includes pediatricians and gastroen- terologists and usually consists of diet modifica- tion, cathartic agents, enemas and psychotherapy. However, 40-50% of patients do not respond to medical treatments, so the surgery orientation has played an increasingly important role over the last decade (1,2). In the past, the surgical approach was limited to the treatment of complications of consti- pation and correction of anorectal anomalies. Re- cently, this role has expanded and surgical treat- ments now include: internal sphincter myomectomy and access for antegrade enemas by right cecosto- my. For diagnostic accuracy, transanal rectal biopsy is practiced. (3-6) According to Rome III criteria (2006), chronic constipation is defined by: the presence of 2 or few- er bowel movements per week; at least 1 episode of fecal incontinence per week; a history of adoption of voluntary retention posts or excessive retention of feces; difficult removal or disposal of faeces of increased consistency; presence of faeces in the rectum; removal of faeces of increased diameter. The diagnosis is supported in children aged 0-4 years if at least two criteria were present in at least 1 month and children over 4 years if at least two criteria were present at least 1 time per week for a minimum of 2 months. (1) Intestinal fecal incontinence is the loss of con- trol, resulting in involuntary passage of stool. This