Breaking through the blockage Advances in care for children with functional constipation

This dissertation aims to “break through the blockages” in our understanding and care of children with functional constipation by providing new insights into both evaluation and management. Part I focuses on the evaluation of children with functional constipation. Chapter 1 describes the interrater reliability of high-resolution anorectal manometry studies. In chapter 2, outcomes of colonic manometry catheter placement during colonoscopy and using fluoroscopy are compared. Chapter 3 evaluates the effect of glycerin on colonic motility and compares the response induced by both bisacodyl and glycerin in children undergoing colonic manometry. In chapter 4, anorectal and colonic motility in children with tethered cord syndrome are described and compared to the findings in children with functional constipation.

Part II addresses the therapeutic management of children with intractable constipation. Chapter 5 explores the diagnostic and treatment practices among pediatric gastroenterologists worldwide for children with intractable constipation. Chapter 6 systematically reviews the literature to investigate the outcomes following antegrade continence enema treatment in children with functional constipation, specifically focusing on treatment success. Chapter 7 describes the colonic motility and anatomy utilizing both colonic manometry and contrast enema studies in children treated with antegrade continence enemas. In chapter 8 the feasibility, efficacy, and safety of percutaneous posterior tibial nerve stimulation compared to sham stimulation in children with functional constipation due to pelvic floor dyssynergia is evaluated.