[Functional constipation: prospective study and treatment response].
OBJECTIVE
To assess the prevalence of functional constipation (FC) with and without encopresis, the factors involved in its onset, and treatment response.


METHODS
A prospective study of 62 children was performed using a standard questionnaire (onset-age, regular toilet use, encopresis, complications, dietary habits and environmental and psychological factors) and physical and anthropometric assessment. FC was defined as a stool frequency of less than 3 bowel movements/week, with passage of large or scybalous stools, with or without 2 or more soiling episodes per week, without underlying disease. Treatment included demystification, behavioral modification and drugs (mineral oil and senna). Each child was periodically re-evaluated, and treatment was considered successful when the defecation rate was 3 or more bowel movements/week, discomfort was absent, and fecal soiling frequency was 2 or fewer episodes/ month.


CONCLUSIONS
FC accounted for 13 % of all first consultations (60 % boys, 40 % girls; mean age at diagnosis 6.1 years). The most frequent manifestations were painful defecation (60 %), rectorrhagia (42 %), obstructive episodes (34 %) and anal fissure or hemorrhoids (17 %); 19 patients (31 %) had encopresis. Nutritional assessment revealed that 84 % of the patients was well nourished and 16 % was overweight. Fiber intake was deficient in more than 60 %. Sixteen (26 %) patients underwent successful relief of impaction with senna (20-30 mg/dose) combined with mineral oil. Maintenance treatment included mineral oil (15-30 ml/day) and senna at the minimum effective dose (5-15 mg/day). Satisfactory results were achieved 1 month later in 32 % of the children, 3-6 months later in 71 %, and 6-12 months later in 85 %; successful response was closely related to regular toilet habits, dietary modification and a shift in the family's attitude.
Martínez-Costa
C
C
Servicio de Pediatría, Hospital Clínico, Universidad de Valencia, España. ceciliam@comv.es
Palao Ortuño
M J
MJ
Alfaro Ponce
B
B
Núñez Gómez
F
F
Martínez-Rodríguez
L
L
Ferré Franch
I
I
Brines Solanes
J
J
D000293:Adolescent; D002400:Cathartics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003248:Constipation / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D004035:Diet Therapy / Q000379:methods; D004688:Encopresis / Q000188:drug therapy / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008899:Mineral Oil / Q000627:therapeutic use*; D010146:Pain / Q000453:epidemiology; D010353:Patient Education as Topic; D015995:Prevalence; D011446:Prospective Studies; D012676:Senna Extract / Q000627:therapeutic use*; D016896:Treatment Outcome
D002400:Cathartics; D012676:Senna Extract; D008899:Mineral Oil