Recently I attended a terrific talk by my partner, Jose Garza.  This lecture provided a great deal of information on refractory constipation for both pediatricians and pediatric gastroenterologists alike.

Elements of the talk included diagnosis, pathophysiology and differential diagnosis.

Rome III Criteria -Helpful in Diagnosis of Constipation

Is it Hirschsprung’s Disease?

Some of the more useful points.

1. AXR should not be used to make diagnosis of constipation.
2. Many refractory constipation patients are stooling fine and actually labeled as constipation instead of a functional abdominal pain disorder.  That is, they are complaining of stomach pain and have been erroneously told they are constipated (see point #1).
3. Miralax remains a 1st line agent for constipation. In individuals with fecal soiling, if miralax is not working and they have had appropriate cleanout, then senna laxative may be helpful.
4. Sitz markers are particularly helpful in proving stooling when teenager claims to not be stooling for a month and in proving functional fecal retention rather than nonretentive soiling.
5. If good treatment is not working, then refer to neurogastroenterology.

Related blog posts:

• What’s Wrong with Ordering an AXR for Constipation in the …
• Miralax -More Scrutiny, Research Study | gutsandgrowth
• It’s worth the cost | gutsandgrowth
• AGA Constipation Guidelines | gutsandgrowth
• Miralax Safety – gutsandgrowth – WordPress.com