Overview

• Most cases are idiopathic/functional constipation (90-95%).
  • Secondary Causes → hirschsprung’s disease, cystic fibrosis (esp. if meconium ileus), hypothyroidism, spinal cord lesions, sexual abuse, intestinal obstruction, anal stenosis, cows milk intolerance.
• Lifestyle Factors → low-fibre diet, poor fluid intake, sedentary lifestyle, psychosocial problems (difficult home or school environment).

Making Diagnosis

Clinical Features

• <3 stools per week.
• Hard stools that are difficult to pass.
• Rabbit dropping stools.
• Straining and painful passage of stools.
• Abdominal pain.
• Abnormal posture → retentive posturing.
• Faecal impactation causing overflow diarrhoea.

RED FLAGS (= REFER) → failure to pass meconium in first 24 hours, failure to thrive, abdominal distension, lower limb weakness/numbness, ribbon stool pattern (anal stenosis).

‘Ballotable Mass’ → indicates kidney mass rather than faecal impacation. Urgent referral.

Investigations

Management Plan