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World Journal of Gastroenterology Feb 2023Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence... (Review)
Review
Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. Its pathophysiological mechanisms are thought be multifactorial and complicated, resulting in difficult management. Currently, the most effective medication, when used in parallel with toilet training, is osmotic laxatives. Children's adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure. Recently, novel therapies with a high safety profile have been developed, such as probiotics, synbiotics, serotonin 5-hydroxytryptamine 4 receptor agonists, chloride channel activators, and herbal and transitional medicines; nonetheless, well-designed research to support the use of these therapies is needed. This review aims to focus on multiple aspects of FC in children, including global prevalence, pathogenesis, diagnostic criteria, tools, as well as conventional and novel treatment options, such as non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators. We also report that in very difficult cases, surgical intervention may be required.
Topics: Child; Humans; Dietary Fiber; Constipation; Laxatives; Physical Therapy Modalities; Physicians
PubMed: 36925458
DOI: 10.3748/wjg.v29.i8.1261 -
Paediatric Drugs May 2023Functional constipation is a common problem in childhood worldwide and has a great impact on social, physical, and emotional functioning of affected children and their... (Review)
Review
Functional constipation is a common problem in childhood worldwide and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. It is a clinical diagnosis based on the Rome IV criteria. Non-pharmacological treatment involves education, demystification, lifestyle advice, and toilet training. Pharmacological treatment consists of disimpaction, maintenance treatment, and eventually weaning if possible. Polyethylene glycol is considered as the first choice of laxative for both disimpaction and maintenance treatment. Different osmotic laxatives, stimulant laxatives, lubricants, and enemas are available as alternative pharmacological treatment options. Novel drugs are emerging but evidence to support the widespread application of these drugs in the pediatric population is often lacking and more high-quality research is needed in this field. If children remain symptomatic despite optimal pharmacological treatment, botulinum toxin injections in the anal sphincter can be considered as an alternative, more invasive treatment option. This review provides an update on currently available literature concerning the pharmacologic treatment of functional constipation in children.
Topics: Child; Humans; Laxatives; Constipation; Polyethylene Glycols
PubMed: 36941393
DOI: 10.1007/s40272-023-00563-0 -
Singapore Medical Journal Feb 2020Constipation is common in infants and children. Helping parents understand the vicious cycle of childhood chronic constipation is the key to successful management....
Constipation is common in infants and children. Helping parents understand the vicious cycle of childhood chronic constipation is the key to successful management. Weaning, toilet training, transitions to kindergarten/school, a bout of febrile illness and overseas holidays are common life milestones that may be associated with an increased risk of constipation. A detailed history and targeted physical examination can rule out most organic causes of chronic constipation. Infrequent defecation (≤ 2 per week), faecal incontinence, retentive posturing, painful or hard bowel movements or large diameter of stool suggest functional constipation. The Bristol stool chart is a free, useful tool for parents or caregivers to report and monitor the child's stools. Red flags in constipation include delayed passage of meconium beyond 48 hours of life, associated intestinal obstruction symptoms, developmental delays, behavioural problems and frequent soiling of underwear. Behavioural modifications should be considered in primary care, together with pharmacotherapy such as laxatives.
Topics: Behavior Therapy; Child, Preschool; Chronic Disease; Constipation; Female; Humans; Infant; Infant, Newborn; Male; Parents; Physician-Patient Relations
PubMed: 32152637
DOI: 10.11622/smedj.2020014 -
Deutsches Arzteblatt International Oct 2022According to a population-based study, approximately 6.8% of children and adolescents in Germany suffer from acute or chronic constipation. It can be of organic or...
BACKGROUND
According to a population-based study, approximately 6.8% of children and adolescents in Germany suffer from acute or chronic constipation. It can be of organic or functional origin and may be associated with comorbid disturbances, particularly fecal incontinence.
METHODS
We selectively searched the PubMed and Google Scholar databases for articles with the keywords "constipation," "children and adolescents," and "incontinence". Recommendations are based on the AWMF guideline on constipation and fecal incontinence and on international guidelines and reviews.
RESULTS
More than 90% of cases of chronic constipation are of functional origin. Organic causes vary with age and call for targeted differential diagnosis. Invasive tests are only rarely necessary. Functional constipation may be associated with fecal and urinary incontinence, and the relative risk of urinary tract infections is 2.2 to 6.5. There may be associated psychological symptoms and mental disorders in 30-50% of cases. The cornerstone of treatment is patient and parent education, along with laxative medication and toilet training. Instructional programs have been found effective in otherwise refractory cases.
CONCLUSION
The treatment of constipation in childhood should begin as soon as the differential diagnostic evaluation is completed. The education of parents, follow-up at close intervals, and drug treatment and behavioral therapy that are adapted to the symptoms can improve quality of life.
Topics: Humans; Child; Adolescent; Fecal Incontinence; Quality of Life; Constipation; Urinary Tract Infections; Behavior Therapy
PubMed: 36261928
DOI: 10.3238/arztebl.m2022.0309 -
World Journal of Clinical Pediatrics Sep 2022Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome...
Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.
PubMed: 36185096
DOI: 10.5409/wjcp.v11.i5.385 -
American Family Physician Oct 2019
Topics: Adult; Child, Preschool; Female; Humans; Infant; Male; Parent-Child Relations; Parents; Surveys and Questionnaires; Toilet Training; United States
PubMed: 31613579
DOI: No ID Found -
Journal of Environmental and Public... 2020The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Level of patients' satisfaction is... (Review)
Review
BACKGROUND
The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Level of patients' satisfaction is an important health outcome, which is regarded as a determinant measure for quality of care. This study was performed with the aim of assessing the level of patient satisfaction with inpatient services and its determinants in Black Lion Specialized Hospital, Addis Ababa, Ethiopia.
METHODS
A facility-based cross-sectional study was conducted from November 25 to December 20, 2015, using 398 randomly selected patients. Ethical clearance was obtained from the Jimma University research review board, and verbal consent was also received from the study participants during data collection time. A pretested structured interview questionnaire was used to collect data from study participants. The collected data were handled by using SPSS statistical software. Before analysis, relevant explanatory variables were identified using factor analysis with varimax rotation, and bivariate analysis was carried out using linear regression for every independent variable with the outcome variable independently. Explanatory variables scoring value <-0.05 were used for the final model after checking the assumption. Study findings are presented by using tables, graphs, and description.
RESULTS
A total of 398 patients were participated in the study, yielding a response rate of 100%. A total of 46.2% (95% CI: 41.2%-51.1%) patients were satisfied by the services they received in the hospital. Patient and health care provider interaction and general facility amenity-related domains were found to explain 96.4% of the variability in the net overall satisfaction score. Good quality services provided by hospital physicians, availability of laboratory and radiology services, pain management services, and inpatient pharmacy services of the hospital had positive influences. Besides toilet cleanliness, availability of rooms for accommodation and dietary service had significant relation with level of patient satisfaction. Quality of the inpatient pharmacy service had a great influence on satisfaction; a unit increase in it resulted in 2.3 (95% CI: 2.1-2.5) times increment in patient satisfaction level at ≤ 0.001. For final predictors, regression estimates for level of satisfaction moved from very dissatisfied to very satisfied when service improves by a unit.
CONCLUSION
Overall patients' satisfaction is lower than other studies in the nation. A great opportunity is there to improve patient's satisfaction level if the service quality is improved around the time of patient and health care provider interaction and facility amenity services. Besides, improving the health literacy of service providers and devising a strategy to routinely assess satisfaction level of patients in the facility is critical. On top of this, providing tailored on-the-job training for health care workers in the facility is a crucial step in order to improve their knowledge and skills to render patient-centered quality service to improve their patients' satisfaction. Using a checklist during service delivery may improve client patient interaction and ensure the standard. Facility design dimension can be considered for future research activities.
Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Ethiopia; Female; Humans; Inpatients; Male; Middle Aged; Patient Satisfaction; Young Adult
PubMed: 32855641
DOI: 10.1155/2020/2473469 -
American Family Physician Oct 2019Toilet training is a significant developmental milestone in early childhood. Most U.S. children achieve the physiologic, cognitive, and emotional development necessary...
Toilet training is a significant developmental milestone in early childhood. Most U.S. children achieve the physiologic, cognitive, and emotional development necessary for toilet training by 18 to 30 months of age. Markers of readiness for toilet training include being able to walk, put on and remove clothing, and follow parental instruction; expressive language; awareness of a full bladder or rectum; and demonstrated dissatisfaction with a soiled diaper. Other readiness cues include imitating toileting behavior, expressing desire to toilet, and demonstrating bladder or bowel control (staying dry through a nap or through the night). Physicians should provide anticipatory guidance to parents beginning at about 18 to 24 months of age, noting the signs of toilet training readiness, and setting realistic expectations for parents. Parents should be counseled that no training method is superior to another. Parents should choose a method that is best suited to them and their child, and the method should use positive reinforcement. Complications of toilet training include stool toileting refusal, stool withholding, encopresis, hiding to defecate, and enuresis. These problems typically resolve with time, although some may require further investigation and treatment. Medical comorbidities such as Down syndrome, autism spectrum disorder, and cerebral palsy reduce the likelihood of successfully attaining full toilet training and often require early consultation with occupational therapists, developmental pediatricians, or other subspecialists to aid in toilet training.
Topics: Adult; Child, Preschool; Curriculum; Education, Medical, Continuing; Female; Humans; Infant; Male; Parent-Child Relations; Parents; Surveys and Questionnaires; Toilet Training; United States
PubMed: 31613577
DOI: No ID Found -
International Braz J Urol : Official... 2021Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT.
PURPOSE
Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT.
MATERIAL AND METHODS
We interviewed 372 parents of children who had completed TT up to 48 months before the interview. The questionnaires were applied at school exits when parents went to pick their children up and at public parks. Questions included demographics, aspects related to TT, dysfunction voiding symptom score and evaluation of constipation.
RESULTS
The interviews were performed at a mean of 15.3±10.4 (0 to 47) months after the end of TT. Girls accounted for 53% of the sample. The mean age at finishing TT was 31.6±9.3 months and similar in both genders (p=0.77). TT occurred before school entry in 45.7% of the children and medical advice for TT was sought only by 4.8% of the parents. No association was observed of age at completing TT and presence of lower urinary tract symptoms (LUTS) (p=0.57) and/or constipation (p=0.98). In the univariate analysis, prematurity (OR=2.7 [95% CI 2.3-3.1], p <0.0001) and mothers who work outside their household (OR=1.8 [95% CI 1.4-2.3], p <0.0001) were associated to delayed TT.
CONCLUSION
Children completed TT at a mean of 2 years and 7 months of age. The age of completing TT was not related to LUTS and/or constipation. Premature children and those whose mothers work outside the home finish TT later.
Topics: Child; Constipation; Female; Humans; Lower Urinary Tract Symptoms; Male; Surveys and Questionnaires; Toilet Training
PubMed: 33047922
DOI: 10.1590/S1677-5538.IBJU.2020.0129