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Chronic constipation - Anogenital in
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Chronic constipation - Anogenital in

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Contributors: Mary Spencer MD, Ann Lenane MD, Sireesha Reddy MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
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Synopsis

In most children, constipation is functional and without evidence of a pathological condition. Functional constipation most commonly is caused by painful bowel movements, resulting in voluntary withholding of feces by a child. Toilet training, dietary changes, stressful events, illness, unavailability of toilets, or postponing defecation because the child is too busy can all lead to painful defecation, ultimately causing constipation.

A thorough history is an essential element in evaluating a child with constipation. Important information includes the time after birth of the first bowel movement, how the family defines the term constipation, duration of symptoms, the frequency of bowel movements, the consistency and size of the stools, whether defecation is painful, whether blood has been present on the stool or toilet paper, and if the child experiences abdominal pain. Medications are also an important potential cause of constipation.

History of fever, abdominal distention, anorexia, nausea, vomiting, weight loss, or poor weight gain may suggest an organic disorder. Bloody diarrhea in an infant with a history of constipation could be an indication of enterocolitis secondary to Hirschsprung disease. A psychosocial history is important to assess the family structure, the interactions the child has with peers and the possibility of abuse.

The physical examination should involve external examination of the perineum and perianal area with digital examination of the anorectum to assess perianal sensation, anal tone, the size of the rectum, and the presence of an anal wink. It is important to also determine the amount and consistency of stool and its location within the rectum. It is recommended that a test for occult blood in the stool be performed in all infants with constipation as well as in any child with symptoms suggestive of an organic disorder.

Laxity of the anus and anal dilation may be found with neurologic disorders and chronic constipation, but they may also be consistent with sexual abuse. Anal dilatation of any size is considered a normal reflex if stool is present in the rectal vault or if dilation occurs after the child has been in the prone knee-chest position for more than 30 seconds. However, anal dilatation of 20 mm or greater without stool in the rectal vault is suspicious for abuse.

Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other anogenital conditions.

Codes

ICD10CM:
K59.09 – Other constipation

SNOMEDCT:
236069009 –  Chronic constipation

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Last Updated: 08/15/2016
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Chronic constipation - Anogenital in
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Chronic constipation : Abdominal pain, Constipation, Rectal pain
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