The Pathophysiology of Constipation

Constipation is an extremely common disorder in childhood and is responsible for up to 25% of all pediatric gastroenterological consultations and 3% of all pediatric outpatient visits. In 90% of the cases the disorder is functional in origin and in only 10% is there an underlying organic disorder. Common organic causes of childhood constipation include: congenital defects of the gut; neurologic disease especially cerebral palsy, spinal cord disorders and hypotonia; endocrine and metabolic disorders (hypothyroidism, cystic fibrosis, hypercalcemia, diabetes mellitus, renal acidosis), and the use of constipating drugs such as some antacids, sucralfate, iron, codeine-containing medications, imipramine, phenytoin, etc. The commonest of the congenital defects is Hirschsprung’s disease, which has an incidence of 1 in 4,500 live births compared to 1 in 7,000 live births with anorectal malformations, and 1 in 40,000 with other enteric neuromuscular disorders. Fewer than 5% of children presenting for the first time with constipation have demonstrable organic disease. Copyright © 2007 Nestec Ltd., Vevey/S. Karger AG, Basel Peter J. Milla, MD Gastroenterology Unit, Institute of Child Health 30 Guildford Street London WC1N 1EH (UK) Tel. +44 207 9052 632, Fax +44 207 4391 791, E-Mail [email protected] © 2007 Nestec Ltd., Vevey/S. Karger AG, Basel 0517–8606/07/0652–0055$23.50/0 Accessible online at: www.karger.com/ane D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /8 /2 01 7 7: 07 :1 3 P M