Management of functional constipation in children and adults.

Mana H Vriesman, Ilan J N Koppen, Michael Camilleri, Carlo Di Lorenzo, Marc A Benninga

Journal: Nature reviews. Gastroenterology & hepatology 2020;17(1):21-39

PMID: 31690829

Full Text on Nature Publishing Group View on PubMed

Abstract

Functional constipation is common in children and adults worldwide. Functional constipation shows similarities in children and adults, but important differences also exist regarding epidemiology, symptomatology, pathophysiology, diagnostic workup and therapeutic management. In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives. In adults, management focuses on excluding an underlying cause and differentiating between different subtypes of functional constipation - normal transit, slow transit or an evacuation disorder - which has important therapeutic consequences. Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions (in the presence of a rectal evacuation disorder) and pharmacological therapy. When conventional treatments fail, children and adults are considered to have intractable functional constipation, a troublesome and distressing condition. Intractable constipation is managed with a stepwise approach and in rare cases requires surgical interventions such as antegrade continence enemas in children or colectomy procedures for adults. New drugs, including prokinetic and prosecretory agents, and surgical strategies, such as sacral nerve stimulation, have the potential to improve the management of children and adults with intractable functional constipation.

Address: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands. [email protected].; Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.; C.E.N.T.E.R. Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.; Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.

DOI: 10.1038/s41575-019-0222-y

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https://doi.org/10.1038/s41575-019-0222-y

MeSH Terms: Adult, Bile Acids and Salts, Biofeedback, Psychology, Child, Chloride Channel Agonists, Cholinesterase Inhibitors, Constipation, Diet Therapy, Dietary Fiber, Disease Management, Electric Stimulation Therapy, Enema, Gastrointestinal Agents, Gastrointestinal Microbiome, Gastrointestinal Transit, Guanylyl Cyclase C Agonists, Humans, Laxatives, Manometry, Patient Education as Topic, Prebiotics, Probiotics, Serotonin 5-HT4 Receptor Agonists, Toilet Training