Rationale and Comments

The association of lower urinary tract dysfunction and constipation is termed bladder-bowel dysfunction. Of children with function constipation, 25% to 30% have daytime urinary incontinence. Treatment of constipation alone can eliminate daytime urinary incontinence in many patients. It has also been shown to reduce recurrent UTI. The clinical diagnosis of constipation can be made using the Rome IV criteria. Treatment strategies involve education, fecal disimpaction in many, prevention of re-accumulation with maintenance regimens, and close follow-up. If a child is started on anti-cholinergic medications, the bowel regimen must be continued to obviate worsening constipation.

Sponsoring Organizations

• American Academy of Pediatrics - Section on Urology

Sources

• Systematic review

Disciplines

• Pediatric
• Urologic

References

• Colombo JM, Wassom MC, Rosen JM. Constipation and encopresis in childhood. Pediatr Rev. 2015;36(9):392-402.
  
• van Summeren JJGT, Holtman GA, van Ommeren SC, et al. Bladder symptoms in children with functional constipation: a systematic review. J Pediatr Gastroenterol Nutr. 2018;67(5):552-560.
  
• Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV [published online ahead of print, 2016 Feb 19]. Gastroenterology. 2016;S0016-5085(16)00223-7.
  
• Loening-Baucke V. Functional fecal retention with encopresis in childhood. J Pediatr Gastroenterol Nutr. 2004;38(1):79-84.
  
• Burgers RE, Mugie SM, Chase J, et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children's Continence Society. J Urol. 2013;190(1):29-36.