Childhood constipation as an emerging public health problem

Abstract

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.