THE MANAGEMENT OF CHRONIC CONSTIPATION IN PEDIATRIC PATIENTS

Introduction. Chronic constipation is a common reason for a pediatric patient to visit a doctor and we think that the number of cases is increasing but only a few patients are diagnosed with Hirschsprung disease. Aim. This study aims to clarify the difference between the two most common causes of chronic constipation in pediatric patients: habitual constipation and Hirschsprung’s disease regarding symptoms, clinical findings, investigations and treatment and to identify what is more important for the patients with chronic constipation: to go further with investigations after the clinical examination or to start the medical treatment as soon as possible in orther to establish a conduit in the management of these patients. Material and method. We present an observational, descriptive and retrospective 4 years study on children diagnosed with chronic constipation. Results. 122 patients were included in this study, in 3 cases Hirschsprung’s disease was diagnosed. As a complication of chronic constipation 58% of the patients had rectorrhagia and at local examination were found 34 patients with fecaloma, 32 with anal fissure and 5 with hemorrhoids, but none of these findings were associated with Hirschsprung disease. Only in 36% of the cases further investigations were needed. The average age at the first examination was 4 years and 3 months and the average age for the patients with rectorrhagia was 5 years and 3 months. Conclusions. The number of children with chronic constipation is increasing. Rectorhhagia, fecalomas, anal fissures and hemorrhoids are associated with habitual constipation but not with Hirschsprung disease. Because of the small number of cases diagnosed with Hirschsprung disease, the fact that the mean age of the children with rectal bleeding is 1 year higher than the one of the group and the small percentage of further investigation needed, we consider that in order to early prevent complications personalized medical treatment is needed and further investigations should not delay the begining of nursing.