Functional constipation is more common than you may think, up to 9.5 % of children and 14% of adults worldwide are affected. Functional constipation is when there is no known underlying cause such as a neurogenic or organic disease.
Vriesman et al review functional constipation in adults and children with a focus on similarities and differences in symptoms, diagnostics and therapeutic management. Clinical symptoms of functional constipation may be difficult to describe, in general for adults it is defined as infrequent bowel movements often accompanied by symptoms of bloating and abdominal pain. Children with functional constipation often have accompanying fecal and urinary incontinence and urinary tract infections. The Rome IV criteria are an international effort to create scientific data to help in the diagnosis and treatment of functional gastrointestinal disorders.
Functional constipation is when there is no known underlying cause such as a neurogenic or organic disease. However, the reasons for functional constipation are often multifactorial in both children and adults and may be a combination of; genetic factors, lifestyle, microbiome, colonic motility, anorectal physiology, psychological and/or behavioral factors, and for children – a parental factor as well.
Management of functional constipation in both children and adults is a stepwise process. The first step is nonpharmacological, including education and lifestyle adjustments. This step may solve the problem for some patients, but if not, pharmacological interventions may be needed. There are several different pharmacological agents for both children and adults. The challenge with pharmacological treatment is adherence to the treatment and some that adhere to treatment will remain symptomatic. As many as 40% of children treated for functional constipation were still symptomatic after 6-12 months on pharmacological treatment. For those unresponsive to pharmacological treatment, transanal irrigation (TAI) is the next step that has been shown to be effective. The last resort, after failure of other therapies and with symptoms greatly disrupting the quality of life for the patient, is surgical intervention.