Assessment, diagnosis, and treatment of constipation in childhood.

The evaluation of chronic constipation with or without fecal soiling in children must begin with a careful history and physical examination. Constipation and fecal soiling is caused in fewer than 10% of patients by anatomic, neurologic, endocrine, or metabolic conditions. No specific organic cause can be found in more than 90% of affected children, but anorectal functions--such as rectal sensation, rectal contractility, and relaxation of the external anal sphincter and pelvic floor muscles during straining for defecation--are impaired. Most patients will benefit from a program designed to clear fecal impaction with enemas, prevent fecal impaction with enemas, prevent fecal impaction with laxatives, and promote regular bowel habits with scheduled toilet sittings.