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Diagnosis and management in chronic constipation in children age (Part II)
Constipation is a common health problem that affects children of all ages. The etiology is often functional, being the result of voluntary retention of the stool. A complete case history and a detailed physical examination are essential for an appropriate diagnosis. In most cases laboratory investigations are not required; they are indicated when a suspicion of an organic cause occurs (Hirschsprung disease, pseudoobstruction, hypothyroidism, diabetes insipidus, cystic fibrosis, congenital anorectal malformations) or in treatment-resistant cases. Early diagnosis is extremely important being associated with a better response to therapy. This includes performing DRE, colonoscopy, scintigraphy, colon videocapsule and anorectal manometry. The first stage of functional constipation treatment consists in desimpactation. Polyethylene glycol is effective and well tolerated. After desimpactation, a long-term maintenance program is necessary, due to increased frequency of relapses. Maintenance drugs include mineral oil, lactulose, polyethylene glycol and sorbitol. A diet rich in dietary fiber associated with family support and, when possible, child education are essential. The delay in diagnosis and treatment can lead to the progression into a chronic health problem with physical, psychological and social implications.
Key words: constipation, colonoscopy, anorectal manometry, child