Defecation disorders in children: Epidemiology and risk factors

Defecation disorders (constipation and fecal incontinence) are widely prevalent functional gastrointestinal disorders in children. Although the pathophysiology of constipation is not known to the precision, there seems to be association with a significant number or socio-cultural factors.
Epidemiological patterns of defecation disorders in Sri Lankan children were lacking. In an epidemiological survey, we noted that 15.3% of school children were suffering from chronic constipation and 2.6% were suffering from fecal incontinence. Constipation had an inverse relationship with age and was associated with straining, abdominal pain and blood in the stools. We also found that defecation disorders are associated with both home and school related psychological stress. It was also found that stress generated by the civil war which plagued the country for 3 decades, and all forms of child maltreatments, predisposed children to develop constipation. In addition, children with constipation were suffering from an array of somatic symptoms. They had poor health-related quality of life in all domains and associated fecal incontinence with constipation reduced quality of life to even lower levels. Despite this, surprisingly, only 3% of them sought healthcare consultation for their symptoms.
Management of defecation disorders involves several facets. The pharmacological interventions include judicial use of osmotic and stimulant laxatives for children with constipation and loperamide in children with fecal incontinence. Controlling the dietary factors, neuromodulation and surgical interventions are the other possible therapeutic modalities. Above all, controlling the psychosocial factors and making world more safer place for children will reduce the disease burden and the healthcare expenditure.