Management of functional constipation in children and adults

Functional constipation is common in children and adults worldwide. Functional constipation shows similarities in children and adults, but important differences also exist regarding epidemiology, symptomatology, pathophysiology, diagnostic workup and therapeutic management. In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives. In adults, management focuses on excluding an underlying cause and differentiating between different subtypes of functional constipation — normal transit, slow transit or an evacuation disorder — which has important therapeutic consequences. Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions (in the presence of a rectal evacuation disorder) and pharmacological therapy. When conventional treatments fail, children and adults are considered to have intractable functional constipation, a troublesome and distressing condition. Intractable constipation is managed with a stepwise approach and in rare cases requires surgical interventions such as antegrade continence enemas in children or colectomy procedures for adults. New drugs, including prokinetic and prosecretory agents, and surgical strategies, such as sacral nerve stimulation, have the potential to improve the management of children and adults with intractable functional constipation. Functional constipation is common in children and adults worldwide. Here, the authors provide an overview of the differing management strategies for childhood and adult functional constipation, including insights into epidemiology, pathophysiology, diagnosis and therapy. Key points Diagnosis of functional constipation is based on a thorough medical history and physical examination; additional testing is only indicated if alarm symptoms are present or conventional strategies fail. Functional constipation can be caused by lifestyle factors, psychological factors and behavioural factors; withholding behaviour is a key factor in the pathophysiology of childhood functional constipation, whereas adults often have dyssynergic defaecation patterns. In adults, additional testing is used to differentiate between different subtypes of functional constipation (normal transit, slow transit and evacuation disorders) as such information has important therapeutic consequences. Patients with intractable constipation should be referred to a gastroenterologist for further mana