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Background: Functional constipation (FC) in children is a common gastrointestinal disorder with a worldwide-pooled prevalence of 9.5%. Complaints include infrequent bowel movements, painful defecation due to hard and/or large stools, faecal incontinence, and abdominal pain. Prebiotic oligosaccharides have been shown to relieve constipation symptoms in young adults and elderly. However, sufficient evidence is lacking linking additional prebiotic intake to improve symptoms in children with FC. We hypothesise that prebiotic oligosaccharides are able to relieve symptoms of constipation in young children as well. Methods: In the present randomised, double-blind, placebo-controlled, multi-centre study, we will study the effects of two prebiotic oligosaccharides in comparison to placebo on constipation symptoms in children of 1–5 years (12 to 72 months) of age diagnosed with FC according to the Rome IV criteria for functional gastrointestinal disorders. The primary outcome measure will be change in stool consistency. Secondary outcomes include stool frequency and stool consistency in a number of cases (%). Tertiary outcomes include among others painful defecation, use of rescue medication, and quality of life. In addition, the impact on gut microbiome outcomes such as faecal microbiota composition and metabolites will be investigated. Participants start with a run-in period, after which they will receive supplements delivered in tins with scoops for 8 weeks, containing one of the two prebiotic oligosaccharides or placebo, followed by a 4-week wash-out period. Discussion: This randomised double-blind, placebo-controlled multi-centre study will investigate the effectiveness of prebiotic oligosaccharides in children aged 1–5 years with FC. Trial registration: ClinicalTrials.gov NCT04282551. Registered on 24 February 2020.

BACKGROUND: In the last decades, the average age for toilet training has increased in the western world. It is suggested that the postponed initiation of toilet training is a contributing factor to problems related to bowel and bladder control. Functional gastrointestinal and urinary tract disorders are prevalent in childhood, causing suffering in affected children and for their families, and consuming healthcare resources. To evaluate whether assisted infant toilet training can prevent functional gastrointestinal and urinary tract disorders in young children, we are conducting a randomized intervention study with a 4-year follow-up. METHODS: This randomized two-armed intervention study will include 268 Swedish infants recruited at six child healthcare centers in Region Dalarna located in the central part of Sweden. The intervention entails parents being instructed and practicing assisted infant toilet training with their child. Children are randomized to start assisted infant toilet training at 0-2 months or at 9-11 months of age. The primary objective is to determine the efficacy of assisted infant toilet training initiated at 0-2 months on the prevalence of functional gastrointestinal disorders (defined as infant colic, infant dyschezia and/or functional constipation) up to the age of 9 months. Secondary objectives are to evaluate whether assisted toilet training initiated during the first year of life reduce the prevalence of functional gastrointestinal disorders (defined as functional constipation, gastrointestinal symptoms and/or stool toileting refusal) and urinary tract disorders (defined as bladder dysfunction and/or urinary tract infections) up to the age of 4 years. Furthermore, infant-to-mother attachment, parental stress, the toilet training process and overall parental experiences will be evaluated/explored. DISCUSSION: This protocol article presents the rationale and design of a randomized two-armed intervention study that will determine the efficacy, Funding agencies:Center for Clinical Research Dalarna, Region DalarnaRegional Research Council of Uppsala-Örebro, Sweden

Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life. Aim To explore parents´ experiences of living with a child with FC and its impact on everyday family life. Method A qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1–14 years affected by FC. Findings Shame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame. Conclusion FC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed. Practice implications Healthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC.

Objective: To evaluate the effectiveness and safety of nonpharmacologic interventions for the treatment of childhood functional constipation. Study design: Randomized controlled trials (RCTs) evaluating nonpharmacologic treatments in children with functional constipation which reported at least 1 outcome of the core outcome set for children with functional constipation. Results: We included 52 RCTs with 4668 children, aged between 2 weeks and 18 years, of whom 47% were females. Studied interventions included gut microbiome-directed interventions, other dietary interventions, oral supplements, pelvic floor-directed interventions, electrical stimulation, dry cupping, and massage therapy. An overall high risk of bias was found across the majority of studies. Meta-analyses for treatment success and/or defecation frequency, including 20 RCTs, showed abdominal electrical stimulation (n = 3), Cassia Fistula emulsion (n = 2), and a cow's milk exclusion diet (n = 2 in a subpopulation with constipation as a possible manifestation of cow's milk allergy) may be effective. Evidence from RCTs not included in the meta-analyses, indicated that some prebiotic and fiber mixtures, Chinese herbal medicine (Xiao'er Biantong granules), and abdominal massage are promising therapies. In contrast, studies showed no benefit for the use of probiotics, synbiotics, an increase in water intake, dry cupping, or additional biofeedback or behavioral therapy. We found no RCTs on physical movement or acupuncture. Conclusions: More well-designed high quality RCTs concerning nonpharmacologic treatments for children with functional constipation are needed before changes in current guidelines are indicated.

© 2020 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd Aim: The aim was to explore the lived experiences of parents who give oral and rectal pharmacological treatment to their children with functional constipation at home. Design: A phenomenological design with a reflective lifeworld research approach that describes phenomena as they are experienced by individuals. Methods: From January–May 2019, 15 interviews were conducted with parents of children with functional constipation with home-based oral and rectal treatment. Parents were recruited from three different healthcare levels. Open-ended questions were used starting from the description of a normal day with constipation treatment. Analyses were made with an open and reflective ‘bridling’ attitude. Findings: Constipation treatment causes parents to question their parental identity and what it means to be a good parent. Forced treatment makes them feel abusive and acting against their will as parents. There is a conflict between doubt and second thoughts about the treatment, the urge to treat based on the child's needs and encouragement from healthcare professionals to give treatment. Conclusion: As pharmacological constipation treatment can be experienced as challenging, it is important to help parents make an informed decision about how such treatment should be carried out at home. The findings reveal a medical treatment situation where parents hesitate and children resist, resulting in insecure parents who question their parental identity. Impact: The findings point to the importance of supporting parents in treatment situations. Healthcare providers need to treat children with constipation with greater focus and more prompt management to prevent these families from lingering longer than necessary in the healthcare system.

Objectives: Constipation is a common problem in children, and most of the time, the cause is defined as functional. Our hypothesis is that children with functional refractory constipation had anatomic alterations of the colon. Methods: All children with chronic refractory constipation who visited our centre underwent accurate clinical examination, contrast enema (CE), anorectal manometry (ARM) and rectal suction biopsies (RSB). In case of functional constipation, three operators measured the size of the colon using radiograms and calculated the ratio based on the width of the second lumbar vertebra. The measurements carried out were compared with those reported in the literature on patients of the same age without constipation. Results: Over a period of 24 months, 69 patients with chronic refractory constipation, aged between 1 and 14 years, visited our department. A CE was performed on 67, and 2 were excluded because of anal stenosis. Sixty-five underwent anorectal manometry. Rectal suction biopsies were needed in 14 children, and 2 of them were found to have colonic aganglionosis. After a complete evaluation, 57 (82.61%) patients were diagnosed having functional constipation. By comparing the data of the patients with those of normal children reported by the other authors, we found that none of the measurements was statistically significant except for the rectosigmoid length: the mean value in one-year-old patients was 19.03 vs. 9.75, and in older children, it was 19.46 vs. 9.59. Conclusions: Recognizing an anatomic anomaly in patients suffering from functional constipation is important for specific treatment, especially when the ratio (rectosigmoid length/L2) is higher than 15.

As of now, constipation in children, especially in infants, is a common complaint during a visit to a pediatrician and a gastroenterologist. Despite the fact that the current internationally recognized guidelines for the management of these patients have been elaborated, domestic specialists have no consensus regarding the therapy and prevention of constipation in children so far. The article discusses the diagnosis and treatment of functional constipations in children. Recommendations on the diagnosis, comprehensive prophylaxis and treatment of functional constipations in children with the inclusion the laxatives are provided, as well as own observations and experience with the polyethylene glycol 4000 (Macrogol) in the therapy of constipation in children., В настоящее время запор у детей, особенно первых лет жизни, является одной из основных жалоб, которые предъявляют родители как на приеме у педиатра, так и у гастроэнтеролога. Несмотря на разработку современных международных рекомендаций по ведению данной группы больных, у отечественных педиатров до сих пор наблюдается искаженное представление о терапии и профилактике запоров у детей. В статье обсуждаются вопросы диагностики и терапии функциональных запоров у детей. Описаны рекомендации по диагностике и комплексной профилактике и лечению функциональных запоров у детей с включением слабительных препаратов, приводятся собственные наблюдения и опыт применения полиэтиленгликоля 4000 (макрогол) в терапии запоров у детей., На сьогодні запор у дітей, особливо перших років життя, є однією з основних скарг, що пред’являють батьки як на прийомі в педіатра, так і в гастроентеролога. Незважаючи на розробку сучасних міжнародних рекомендацій з ведення даної групи хворих, у вітчизняних педіатрів досі спостерігається спотворене уявлення щодо терапії та профілактики запорів у дітей. У статті обговорюються питання діагностики та терапії функціональних запорів у дітей. Описано рекомендації з діагностики, комплексної профілактики та лікування функціональних запорів у дітей із включенням проносних препаратів, наводяться власні спостереження і досвід застосування поліетиленгліколю 4000 (макрогол) в терапії запорів у дітей.

Background: Many children suffer from functional constipation. In case of functional constipation there is no underlying disease. In Sweden, functional constipation is very common in children. Risk factors include lack of physical activity, irregular toilet habits and insufficient intake of fibers and fluids. Child health nurse has the knowledge and skills to advise and treat children in functional constipation and to support and reduce the suffering. Aim: The aim of the study was to illuminate child health nurses' experiences in the care of children with functional constipation. Method: Ten child health nurses were interviewed during a semi structured interview used openended questions. The interviews were recorded as digital files and transcribed verbatim and then analyzed according to a qualitative content analysis. Results: The child health nurses described experiences in the care of children with functional constipation. There were two categories from the analyzed data: "to base on the child`s needs" and "the child´s physical and psychosocial environment". Conclusion: This study shows the child health nurses experiences in the care of children with functional constipation. The care is based on the childs neeeds and the environment around the child in terms of physical and psychosocial environment is taken into account. The child health nurses should be aware of the reason why parents seek care, how to find the cause of functional constipation and how to relieve the child's suffering. She creates a health promotion meeting with children and parents seeking care for functional constipation.

Olsson, S. Föräldrars upplevelse av egenvård och egenvårdsråd vid förstoppning hos barn: En intervjustudie. Examensarbete i omvårdnad 15 högskolepoäng. Avancerad nivå – Magister. Malmö Universitet: Hälsa och samhälle, Institutionen för vårdvetenskap, 2018. Bakgrund: Trots att förstoppningsproblematik hos barn förekommer hos upp till 30 procent av befolkningen är många barn underbehandlade. Vården består i huvudsak av egenvård som ges av föräldrar till barn i hemmet. Vikten av att rätt egenvård initieras i rätt tid påverkar prognosen för om förstoppningsproblematiken utvecklas till att bli mer svårbehandlad eller inte. Föräldrars upplevelse av egenvård och egenvårdsråd torde kunna ge en fingervisning kring om den evidens som finns kommer ut till de barn som är drabbade och vilken roll specialistsjuksköterskan kan spela för att hjälpa föräldrar till barn med förstoppning.Syfte: Att belysa föräldrars upplevelse av egenvård och egenvårdsråd vid förstoppning hos barn.Metod: Kvalitativa semistrukturerade intervjuer genomfördes med nio föräldrar till barn med förstoppningsproblematik. Intervjuernas innehåll analyserades enligt innehållsanalys med induktiv ansats.Resultat: Tre teman framkom i resultatet: innebörden av egenvård och egenvårdsråd, påverkan på det sociala livet och en känsla av utsatthet. Dessa teman reflekterade hur föräldrar till barn med förstoppningsproblematik kunde uppleva svårigheter att definiera hur, när och varför egenvård kunde behöva ges eller förändras till det egna barnet.Slutsats: Resultatet indikerar att relevant kunskap om egenvård vid förstoppning inte når ut till de familjer som behöver den i behandlingen av det förstoppade barnet. Den specialistutbildade sjuksköterskan torde kunna spela en avgörande roll för föräldrar till barn med förstoppningsproblematik i deras upplevelse och behandling av problematiken.Nyckelord: Egenvård, Funktionell förstoppning, Innehållsanalys, Omvårdnad, Pediatrisk vård, Olsson, S. Parents’ experiences of self-care and advice on self-care when handling childhood constipation: an interview study. Degree project, 15 Credit Points One-year Master, Malmö University: Health and society, Department of Care Science, 2018. Background: Despite a prevalence of up to 30 percent many children with childhood constipation are undertreated. Large part of the treatment for constipation consists of self-care administrated to the child by its parents. The importance of proper self-care initiated in time affects the prognosis of whether the constipation will become treatment resistant or not. Parents' perception of self-care and advice on self-care may be an indicator to whether the evidence-based care is offered to the affected children. It could also indicate what role the nurse specialized in pediatric care can play to help parents and their children with constipation. Aim: This study aimed to highlight parents’ perception of self-care and advice on self-care when having a child with constipation.Method: Qualitative semi structured interviews were conducted with 9 parents of constipated children. The interview material was analysed using content analysis.Results: Three themes were identified; meaning of self-care and self-care advice, impact on social life and a sense of vulnerability. These themes reflected how Parents of children with functional constipation experienced difficulties in defining how, when and why self-care might be needed for their child.Conclusion: The studies result implies that relevant knowledge about self-care does not reach the families who need it the most. A nurse specialised in paediatric care could therefore play a crucial role for parents of children with functional constipation in their experience and treatment of the problem.Keywords: Content analysis, Functional Constipation, Nursing, Paediatric care, Self-care.

Outline Introduction and epidemiology Pathophysiology Classification Evaluation Management Prevention Fecal Impaction Fecal Incontinence

Constipation is not only a critical medical, but also a social problem. Treatment of functional constipation (FC) in young children includes the use of dietary correction and pharmacological therapy. Diet therapy for constipation is aimed at stimulating the intestine motility, stopping spastic conditions and normalizing microbiocenosis. Pharmacotherapy of FC in children should be focus on achieving painless act of defecation and soft consistency of fecal masses. Microlax® is a new in the Ukrainian market combined medication in microclysters that provides fast and reliable relief from constipation. Microlax® has not addicting property and special contraindications. It almost does not cause systemic adverse reactions and does not interact with other drugs., Запоры являются не только значительной медицинской, но и социальной проблемой. Терапия функционального запора (ФЗ) у детей раннего возраста предусматривает применение диетических мероприятий и медикаментозного лечения. Диетотерапия при запорах направлена на стимуляцию моторной активности кишечника, устранение спастических явлений и нормализацию микробиоценоза. Фармакотерапия ФЗ у детей должна быть направлена на достижение безболезненного акта дефекации и мягкой консистенции каловых масс. Новый на украинском рынке комплексный препарат в форме микроклизмы «Микролакс®» обеспечивает быстрое и надежное избавление от запора. Микролакс® не вызывает привыкания, практически не имеет системных побочных эффектов, специальных противопоказаний, не вступает во взаимодействие с другими лекарствами., Запори є не лише значною медичною, але й соціальною проблемою. Терапія функціонального запору (ФЗ) у дітей раннього віку передбачає застосування дієтичних заходів та медикаментозного лікування. Дієтотерапія при запорах спрямована на стимуляцію моторної активності кишечника, усунення спастичних явищ і нормалізацію мікробіоценозу. Фармакотерапія ФЗ у дітей повинна бути спрямована на досягнення безболісного акту дефекації та м'якої консистенції калових мас. Новий на українському ринку комплексний препарат у формі мікроклізми «Мікролакс®» забезпечує швидке і надійне позбавлення від запору. Мікролакс® не викликає звикання, практично не має системних побічних ефектів, спеціальних протипоказань, не вступає у взаємодію з іншими ліками.

Introducció. El restrenyiment funcional (RF) és una síndrome força prevalent la població general en el nostre entorn, especialment en dones i gent gran. És destacable el seu impacte a nivell de recursos sanitaris, així com a nivell de qualitat de vida. La població anciana passa en els darrers anys de la seva vida per uns canvis físics, psíquics i socials que contribueixen habitualment a una major dependència i fragilitat. Objectiu. Conèixer la prevalença de RF segons els fenotips de fragilitat, en la població anciana, així com els factors de risc associats. Descriure els símptomes, fisiopatologia del RF i l'impacte en la qualitat de vida. Metodologia. Per dur a terme aquest estudi es van seleccionar 3 poblacions majors de 70 anys: subjectes residents en la comunitat, subjectes hospitalitzats i subjectes institucionalitzats. Es van recollir variables sociodemogràfiques, sobre comorbiditats i consum de fàrmacs, criteris de fragilitat, diagnòstic de RF segons criteris de Roma III, característiques de les femtes (escala de Bristol), així com característiques de la dieta i consum d'aigua. Es va avaluar la qualitat de vida (QV) mitjançant l'instrument EQ-5D. Es van seleccionar dos subgrups de pacients per realitzat proves funcionals per determinar la fisiopatologia en aquesta població. Resultats. La prevalença de RF en la població comunitària és del 13.5%, en la població hospitalitzada del 50% i en la població institucionalitzada del 58.6%. La prevalença de RF és superior en dones i s'incrementa amb l'edat. La prevalença de RF en pacients fràgils és superior a la dels pacients no fràgils en els tres grups poblacionals (comunitat 12.2% vs 20%, hospital 32.3% vs 67.7% i residència 33.3% vs 53.3%). Els símptomes més freqüents en els grups estudiats són les femtes dures i esforç defecatori. En quant als factors associats, apareixen MPOC (comunitat 21.8%, hospital 56.6%), el tractament amb benzodiazepines (comunitat 24%, residència 66.6%), la pèrdua de pes (comunitat 33.3%), c, Introduction. Functional constipation (FC) is a prevalent force in the general population in our environment, especially in women and the elderly. The impact of FC in terms of health resources as well as quality of life is important. The elderly population spends the last years of his life for a physical, psychological and social contributing regularly to greater dependence and fragility. Goal. The prevalence of FC according to the phenotypes of frailty in the elderly population, as well as risk factors. Describe the symptoms, pathophysiology of the RF and the impact on quality of life (QoL). Methodology. To carry out this study we selected three group of subjects over 70 years a group living in the community, a group of subjects hospitalized and another group of institutionalized subjects. We collected sociodemographic variables, comorbidities and drug consumption, frailty criteria, diagnosis RF Rome III criteria, characteristics of feaces (Bristol scale) and characteristics of diet and water consumption, and quality of life (QoL). We selected two subgroups of patients performed functional tests to determine the pathophysiology of this population. Results. The prevalence of FC in the population living in community is 13.5% in the hospitalized population is 50% and 58.6% of the institutionalized population. FC prevalence is higher in women and increases with age. The prevalence of FC in frailty subjects is higher than robust subjects in the three population groups (12.2% vs 20% community, hospital 32.3% vs 67.7% and 33.3% vs 53.3% in nursing home). The most common symptoms in the study groups are stools and straining. As for the associated factors appear COPD (community 21.8% Hospital 56.6%), treatment with benzodiazepines (community 24% residence 66.6%), weight loss (community 33.3%), falls (hospital 73.3%) and walking slowly (hospital 74.1%). Depending on the clinical subtypes, elderly patients shows an expulsive difficulty profile. Subjects with FC show a percept

Background: The management of bloating is unclear and its relationship with patients' well-being and treatment satisfaction independent of other abdominal symptoms is uncharacterized. We evaluated the association of bloating with patient-reported outcomes. Methods: Thirty-nine centers for functional gastrointestinal disorders joined the laxative inadequate relief survey. We enrolled 2203 consecutive outpatients with functional constipation (FC) or constipation-predominant irritable bowel syndrome (IBS-C) in two cross-sectional waves. Both wave 1 and 2 included the SF-12, the patient assessment of constipation-symptoms (PAC-SYM), and the treatment satisfaction questionnaire for medication (TSQM-2). Wave 2 only included a global rating of change (GRC) scale to assess patients' assessment of efficacy concerning treatment switches occurred in the 3 months prior to the interview. Bloating in the abdomen was defined on the basis of PAC-SYM item 3. Key Results: The average age was 50.1 years (SD, 16.7) and 82.1% of patients were women. The prevalence of bloating was 91.6% (n = 1970). Bloating was associated with SF-12 Physical Composite Score (p < 0.01), SF-12 Mental Composite Score (p < 0.01), GRC (p < 0.01), Satisfaction with treatment effectiveness (p < 0.01), convenience of administration (p < 0.01), and side effects (p < 0.01) after adjustment for possible confounders. Conclusions & Inferences: Our data suggest that patients regard bloating as a key element in assessing clinical changes and treatments' efficacy as this symptom exerts a strong influence on patient-reported outcomes independent of possible confounders and other symptoms of constipation. Our data provide the rationale to investigate the efficacy and tolerability of new treatments specifically addressing this important, yet disregarded, patients' complain.

This thesis particularly focused on the outcomes of constipation, celiac disease auto antibodies, asthma-like symptoms, and atopic dermatitis, which are all prevalent in the general population. In line with this, the main goals of this thesis were to assess: · Infant nutrition: o Consequences of timing of complementary feeding o Determinants of dietary patterns in toddlers · Gastrointestinal outcomes: o Consequences of celiac disease autoantibodies during pregnancy o Nutritional and endocrinological determinants of functional constipation in childhood · Asthma-like symptoms and atopic dermatitis: o Nutritional determinants of asthma-like symptoms and atopic der

An increasing incidence of food allergy, especially to cow's milk proteins, is observed in children living in the industrialized regions of the world. In some cases responding to an eviction diet excluding offending foods, the 'functional' constipation can be caused by inflammation of the intestinal wall infiltrated by eosinophils. Understanding the complex mechanisms involved could help to improve the management of idiopathic functional constipation in children by addressing the aetiology instead of treating the symptoms. © 2006 Lippincott Williams & Wilkins., SCOPUS: re.j, info:eu-repo/semantics/published

Consensus guidelines advocate the treatment of constipation and faecal impaction in order to improve symptoms of urinary frequency, urgency and urinary incontinence and to promote bladder emptying in the absence of urinary tract obstruction. This structured review of the literature was undertaken to search for and appraise evidence to support or negate the hypothesis of this relationship. The search strategy was comprehensive and identified six relevant studies. Two of these had been conducted on an adult population and four studies involved children with constipation. These studies were appraised for methodological quality. It was found that sample sizes were small and evidence was inconsistent. Variable methods of reporting meant that data were not able to be pooled for meta-analysis. Based on the limited and conflicting evidence, it is recommended that further research be undertaken to identify any correlation between bowel and bladder function.

Flankegård, G., Mörelius, E., Duchen, K., & Rytterström, P. (2020). Experiences of parents who give pharmacological treatment to children with functional constipation at home. Journal of Advanced Nursing, 76(12), 3519-3527. https://doi.org/10.1111/jan.14539