OC-41 How i manage my patients with functional constipation

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Constipation can manifest as hard (and often large-diameter) stools, infrequent and painful bowel movements or faecal incontinence, and represents a common complaint in childhood. More than 95% of constipated children suffer from functional constipation (FC), a common condition for both general practitioners and paediatric gastroenterologists. A prompt diagnosis and correct therapy are the keys for a successful management of children with FC. To provide the right diagnosis of FC, a thorough history and attentive physical examination suffice in most cases, according to the ROME IV Criteria (2016). Rarely, depending on the individual condition (and presence of the alarm signs), other diseases (like Hirschsprung’s disease, anatomic abnormalities, metabolic or endocrine disorders) have to be ruled out. Non-pharmacological measures include diet, toilet training and a relaxing familial attitude towards the child. Pharmacological approach includes disimpaction, maintenance of a normal intestinal transit and progressive weaning of medication. In some cases, psychological approach is also necessary. Disimpaction can be performed with high-dose of polyethylene glycol (PEG) or daily enemas. For maintenance, osmotic laxatives (especially PEG) are the first choice after the age of 6 months; in children less than 6 months of age or in those not tolerating PEG, Lactulose can be used. Other laxatives (like mineral oil, milk of magnesia and stimulant laxatives) are recommended as additional (or second-line) treatment. The golden rules of therapy are: give adequate doses, for enough long time and stop gradually. Parents have to be informed that sometimes relapses are possible, when treatment is discontinued. A multidisciplinary treatment is rarely required. Even if the management of CF is well defined, the practice shows the contrary: diagnosis is often delayed, children are submitted to multiple and unnecessary investigations and treatment is not properly considered, with digestive and psychosocial consequences. I present the most frequent mistakes encountered in patients referred to me and possibilities to avoid these errors. It is imperative that physicians become familiar with diagnosing FC, in order to provide a proper management and prevent complications.

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