Initial work-up

• History of onset, frequency of stools, and stool consistency.
• Associated history of soiling, wetting.
• Developmental history, toilet training history.
• Associated behaviour patterns (toilet refusal or withholding behaviours).
• Dietary history (rarely the main cause).
• Physical exam including spine, abdomen and perineal, perianal area.
• Rectal examination is NOT routinely recommended.
• Abdominal x-ray rarely changes management and is NOT recommended.

Recommended pre-referral treatment

• Regular toileting (toilet sits up to 5 minutes, 3 times a day – preferably after meals)
• Behaviour modification diary (record frequency of bowel actions, star charts, rewards).
• Laxative therapy.
• Reassure parents that long term use of laxatives are safe and don't produce a "lazy bowel".
• Encourage a healthy diet and adequate clear fluids.
• Treatment and monitoring often required for months.

When to refer

• Constipation is prolonged (>6 months) and treatment resistant.
• Constipation is associated with soiling / wetting.
• Concern regarding underlying organic cause (Hirschsprung disease or anorectal malformation).

Referral information needed

Please collect and include in your referral as much detail as possible. This will assist triage.

• Previous management – laxative(s) trialed, treatment duration, and outcome.
• Associated symptoms of soiling or wetting (day, night, or both).
• Underlying condition that may explain their constipation. (Please specify)

Resources

• RCH Clinical practice guidelines
• HealthPathways guidelines
• Make a referral: Specialist Clinics
  
  

Parent information:

• Kids Health Info
• Raising Children Network

References and more reading

• Paediatric Handbook (2015). Ninth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

Guideline developed by RCH. First published July 2018. Please read Copyright and Disclaimer