What is the focus of the clinical history to evaluate pediatric constipation?

Updated: Dec 14, 2018
  • Author: Stephen M Borowitz, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

History is often helpful in discriminating functional constipation from Hirschsprung disease (see Differentials). Asking parents when their child passed his or her first bowel movement after birth is particularly important. Most children with Hirschsprung disease have difficulties with constipation dating to birth or shortly after birth. In most published series, more than one half of infants with Hirschsprung disease do not pass meconium during the first 36 hours of life and are diagnosed with constipation within the first 4-6 months of life.

Asking the family about specific symptoms of their child's constipation is also important. Inquiring about the onset and duration of symptoms, whether the passage of bowel movements appears to be painful, and whether any bleeding has been associated with defecation is important.

Asking about a history of fecal incontinence or soiling is also important as many parents confuse fecal soiling (ie, encopresis) with poor hygiene or chronic or recurrent diarrhea.


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