Functional constipation in childhood: current pharmacotherapy and future perspectives.

INTRODUCTION: Childhood constipation is a common problem, varying from mild and short-lived to severe and chronic. In the majority of children, no organic cause can be identified and complaints are, thus, referred to as functional constipation. Infrequent painful defecation in combination with fecal incontinence has a significant impact on a child's quality of life. Pharmacological treatment often consists of fecal disimpaction and maintenance therapy. With current treatment options, results are often disappointing. AREAS COVERED: The aim of this review is to provide an overview of current and future pharmacological therapies for functional constipation in childhood. EXPERT OPINION: Despite the widespread use of laxatives, there is a paucity of evidence to support this practice. No strong conclusions can be drawn on which laxative to prefer over the other. However, polyethylene glycol appears to be a reasonable first choice for maintenance therapy. Due to advances in our understanding of intestinal (patho)physiology, new classes of drugs have been developed. Data from adult studies are promising; however, pediatric data are lacking. Ongoing and future studies have to determine the efficacy and safety of these new drugs in the treatment of functional constipation in children.