Zácpa v ordinaci PLDD

Title in English Constipation in the paediatric practice


Year of publication 2017
Type Article in Periodical
Magazine / Source Pediatrie pro praxi
MU Faculty or unit

Faculty of Medicine

Field Paediatry
Keywords constipation; children; diagnosis; treatment; polyethylene glycol
Description Constipation is a common reason for patients to visit both the general paediatrician and paediatric gastroenterologist. Up to 95% of constipation cases are functional in nature, with only 5% accounting for the so-called symptomatic constipation, occurring in various intestinal and extraintestinal conditions. The diagnosis of functional constipation can be established based on a typical history and clinical manifestations. One must evaluate the warning signs and, subsequently, the success of adequate treatment. When symptomatic constipation is suspected, a multidisciplinary approach is warranted. The treatment of functional constipation must be comprehensive, is often long term, and places considerable demands on the patient, family, and physician. At treatment initiation, it is essential to release the impacted stool using a nonfermentable laxative while trying to minimize manipulation with the rectum. This is followed by an individually tailored maintenance therapy of sufficient duration accompanied by defecation training and regular check-ups. Polyethylene glycol (macrogol 4000) is the laxative of first choice for both phases of the treatment. Dietary modifications and psychological support of the family and child in an often embarrassing situation associated with en-copresis also play an important role in treatment. The last step, once all the constipation symptoms have been managed, is the gradual discontinuation of laxatives. The significance of proper management of children with constipation is also underpinned by the fact that, in up to 20% of children who have chronic constipation, constipation persists to a varying degree in adulthood. Currently, evidence is lacking concerning the majority of guidelines that would follow from randomized controlled trials. Most guidelines are thus based on an expert consensus or synthesis of knowledge in review studies. The therapeutic guidelines presented are particularly applicable to patients with functional constipation.

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