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Am Fam Physician. 2006;73(2):329-330

Although most parents consult family physicians or pediatricians for their child’s constipation, little is known about how constipation is managed by family physicians and whether these treatments are successful. These physicians report a high rate of success with their treatments. Borowitz and colleagues studied the effectiveness of common treatments for childhood constipation.

Children between two and seven years of age presenting to a physician with a first-time complaint of constipation (i.e., fewer than seven bowel movements over a two-week period) were eligible for the study. Parents kept a diary of their child’s bowel habits over two weeks before commencing treatment and again two months after treatment. Treatment type was identified through chart reviews.

Of 119 children completing the study, 75 (63 percent) were free of constipation after two months of treatment. Pediatricians and family physicians were equally effective in treating constipation. Responders had a greater number of baseline bowel movements than nonresponders. Nonresponders were not more likely to have a history of parental or sibling constipation. Most physicians prescribed a stool softener or laxative, such as magnesium hydroxide (77 percent), senna syrup (Senokot; 23 percent), mineral oil (8 percent), or lactulose (8 percent). These treatments were prescribed in fixed dosages once or twice daily, and dosage titrations rarely were recommended. Success was equivalent between treatment choices and was not dependent on dosing regimens. Dietary interventions were recommended for approximately one half of patients. Behavioral interventions such as regular toilet times did not result in better outcomes compared with cases where no behavioral interventions were recommended. Disimpaction followed by the use of laxatives or stool softeners was recommended for 45 percent of patients; these children were more likely to respond than children treated less aggressively. Successful treatment of constipation after two months was related to aggressive treatment.

The authors conclude that family physicians undertreat constipation, as illustrated by the fact that 37 percent of patients in this study remained constipated after two months of treatment. Disimpaction followed by introduction of daily laxatives seemed to produce the best response. Because pain with defecation often leads to further constipation, early and aggressive treatment seems to reduce the likelihood that a child will develop chronic constipation.

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