Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2016; 22(30): 6864-6875
Published online Aug 14, 2016. doi: 10.3748/wjg.v22.i30.6864
Childhood constipation as an emerging public health problem
Shaman Rajindrajith, Niranga Manjuri Devanarayana, Bonaventure Jayasiri Crispus Perera, Marc Alexander Benninga
Shaman Rajindrajith, Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Sri Lanka
Niranga Manjuri Devanarayana, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Sri Lanka
Bonaventure Jayasiri Crispus Perera, Consultant Paediatrician, Asiri Hospital, Kirula Road, Narahempita 10100, Colombo, Sri Lanka
Marc Alexander Benninga, Department of Paediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Academic Medical Centre, Meibergdreef, 1105 AZ Amsterdam, The Netherlands
Author contributions: Rajindrajith S developed the concept and the outline of the article; Rajindrajith S and Devanarayana NM drafted the initial manuscript; Crispus Perera BJ edited the drafted manuscript with a significant intellectual contribution; Benninga MA critically analysed the paper with significant intellectual contribution; and all authors are in agreement with the final manuscript.
Conflict-of-interest statement: Benninga MA is a consultant for Shire, Norgine, Astrazeneca and Sucampo; the other authors have no conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Shaman Rajindrajith, MD, FRCPCH, PhD, Senior Lecturer in Paediatrics, Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Sri Lanka.
Telephone: +94-112-957900 Fax: +94-112-958339
Received: March 16, 2016
Peer-review started: March 19, 2016
First decision: April 14, 2016
Revised: May 16, 2016
Accepted: June 13, 2016
Article in press: June 13, 2016
Published online: August 14, 2016

Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.

Keywords: Constipation, Public health, Risk factors, Prevention

Core tip: Constipation is a common problem in children worldwide. Identified risk factors for constipation are equally distributed in both developed and developing countries. Constipation affects the quality of life of affected children and their parents. It also poses a challenge for existing healthcare systems by incurring significant expenditure. These factors indicate that childhood constipation is emerging as a significant public health problem. Attention to careful toilet training, encouraging correct dietary habits, and creating a safer environment for children would curtail the public health impact of functional constipation.