Effectiveness of an organized bowel management program in the management of severe chronic constipation in children.
BACKGROUND
Chronic constipation is a common problem in children. The cause of constipation is often idiopathic, when no anatomic or physiologic etiology can be identified. In severe cases, low dose laxatives, stool softeners and small volume enemas are ineffective. The purpose of this study was to assess the effectiveness of a structured bowel management program in these children.


METHODS
We retrospectively reviewed children with chronic constipation without a history of anorectal malformation, Hirschsprung's disease or other anatomical lesions seen in our pediatric colorectal center. Our bowel management program consists of an intensive week where treatment is assessed and tailored based on clinical response and daily radiographs. Once a successful treatment plan is established, children are followed longitudinally. The number of patients requiring hospital admission during the year prior to and year after initiation of bowel management was compared using Fisher's exact test.


RESULTS
Forty-four children with refractory constipation have been followed in our colorectal center for greater than a year. Fifty percent had at least one hospitalization the year prior to treatment for obstructive symptoms. Children were treated with either high-dose laxatives starting at 2mg/kg of senna or enemas starting at 20ml/kg of normal saline. Treatment regimens were adjusted based on response to therapy. The admission rate one-year after enrollment was 9% including both adherent and nonadherent patients. This represents an 82% reduction in hospital admissions (p<0.001).


CONCLUSIONS
Implementation of a structured bowel management program similar to that used for children with anorectal malformations, is effective and reduces hospital admissions in children with severe chronic constipation.
University of Utah, Division of Pediatric Surgery, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 2600, Salt Lake City, UT 84113. Electronic address: katie.russell@hsc.utah.edu.
Katie W
KW
Russell
University of Utah, Division of Pediatric Surgery, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 2600, Salt Lake City, UT 84113.
Douglas C
DC
Barnhart
University of Utah, Division of Pediatric Surgery, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 2600, Salt Lake City, UT 84113.
Sarah
S
Zobell
University of Utah, Division of Pediatric Surgery, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 2600, Salt Lake City, UT 84113.
Eric R
ER
Scaife
University of Utah, Division of Pediatric Surgery, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 2600, Salt Lake City, UT 84113.
Michael D
MD
Rollins
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D019468:Disease Management; D004733:Enema; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007422:Intestines / Q000503:physiopathology; D054368:Laxatives / Q000008:administration & dosage*; D008297:Male; D012189:Retrospective Studies; D012676:Senna Extract; D000081226:Sennosides
D054368:Laxatives; D000081226:Sennosides; D012676:Senna Extract
Bowel management; Children; Colorectal; Constipation; Enemas; Laxatives