Functional constipation

Individuals suffering from functional constipation often exhibit hard or lumpy stools, decreased frequency of bowel movements, a feeling of incomplete evacuation or obstruction, straining, and in some cases, stomach pain and bloating. Generally speaking, symptoms are considered chronic if they have persisted for three months or more. Faecal incontinence, which is the involuntary loss of stools in the underwear during toilet training and is brought on by an overflow of soft stools passing around a solid faecal mass in the rectum (faecal impaction), is a common symptom in children. Urinary symptoms, including urine incontinence and urinary tract infections, are frequently observed in children who suffer from functional constipation. == Causes ==

To be considered functional constipation, symptoms must be present at least a fourth of the time. == Diagnosis ==

Functional constipation cannot be diagnosed with particular testing; instead, the Rome criteria, a consensus of experts, is used to make this diagnosis. The Rome IV criteria define functional constipation as meeting at least two of the six requirements given below: • Over ¼ (25%) of defecations involve straining. Along with push and squeeze maneuvers, a comprehensive digital rectal exam (DRE) is a crucial component of the clinical examination. Generally speaking, additional laboratory testing should be carried out only in cases of uncertainty or to rule out underlying medical conditions such as hypothyroidism or celiac disease. Abdominal radiography, with or without the introduction of radio-opaque markers to determine colonic transit time, and abdominal ultrasonography are frequently employed supplementary tests in the diagnosis of constipation. Chronic idiopathic constipation is similar to constipation-predominant irritable bowel syndrome (IBS-C); however, people with CIC do not have other symptoms of IBS, such as abdominal pain. == Treatment ==

Treatment for functional constipation begins with nonpharmacological management. This includes education and lifestyle modifications, such as diet changes, consistent exercise, and guidance on proper body position and behavior when using the restroom. The first treatments for constipation are dietary guidelines, which include the requirement for a regular consumption of fiber and fluids. A normal intake of fiber is advocated for children with functional constipation, as per the criteria of ESPGHAN/NASPGHAN. It is not recommended to increase the consumption of fiber above what is considered normal. In order to effectively treat childhood constipation, it is imperative that parents and children receive counseling. This includes teaching them about the concept of overflow incontinence and the significance of withholding behavior. Children with functional constipation can be treated pharmacologically in two stages: maintenance therapy and faecal disimpaction. High-dose oral polyethylene glycol (PEG) or enemas containing active substances such sodium phosphate, sodium lauryl sulfoacetate, or sodium docusate can be used to induce fecal disimpaction. Maintenance therapy is suggested following successful disimpaction in order to avoid reoccurring stool buildup. Adults rarely need faecal disimpaction, although the methods are comparable, and substantial doses of PEG or magnesium citrate are popular oral therapies. For both adults and children, glycerine or bisacodyl suppositories provide an alternative to enemas. Other often used laxatives include milk of magnesia (magnesium hydroxide) and mineral oil, a lubricant. Functional constipation has been treated with a variety of 5-hydroxytryptamine 4 (5-HT4) agonists. Additionally, serotonin promotes motility by stimulating the mucosa's afferent neurons, which in turn triggers the gastrocolic reflex. == Research ==

A 2014 meta-analysis of three small trials evaluating probiotics showed a slight improvement in management of chronic idiopathic constipation, but well-designed studies are necessary to know the true efficacy of probiotics in treating this condition. Children with functional constipation often claim to lack the sensation of the urge to defecate, and may be conditioned to avoid doing so due to a previous painful experience. One retrospective study showed that these children did indeed have the urge to defecate using colonic manometry, and suggested behavioral modification as a treatment for functional constipation. == See also ==