Functional constipation

Sometimes kids are FOS - full of stool! In today's episode, we talk about how to diagnose and treat functional constipation which is a common cause of abdominal pain in pediatrics and can be a pain in the butt, literally!This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kelly Haas (pediatric gastroenterology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] Points:Functional constipation is constipation not due to any other underlying conditions such as Hirschsprungs, spinal cord dysphraphism, or other disease. Functional constipation is defined as having at least 1 month of symptoms in kids younger than 4 years old (or) symptoms at least once per week for at least 2 months in kids older than 4 years old who do not meet IBS criteria. Symptoms include 2 or fewer stools per week, at least 1 episode of incontinence per week after toilet training is established, a history of excessive stool retention/retentive posturing/excessive volitional stool retention, a history of hard or painful bowel movements, the presence of large fecal mass in rectum, or a history of large diameter stools that may obstruct the toiletEncopresis is liquid stool that goes around large stool balls and is indicative of constipation rather than diarrheaPolyethylene glycol (PEG, miralax), lactulose, and enemas are all good treatment options for constipationSources:Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Tabbers MM, et al. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274. doi:10.1097/MPG.0000000000000266 Constipation. Neal S. LeLeiko, et al. Pediatr Rev (2020) 41 (8): 379–392. https://doi.org/10.1542/pir.2018-033