Perform a digital rectal examination on every young child with chronic constipation to exclude underlying anatomic abnormalities that might account for the constipation such as an imperforate anus with perineal fistula, intestinal obstruction (mass effect), or Hirschsprung disease.

Constipation accounts for 5% of pediatric office visits and up to 25% of referrals to pediatric gastroenterologists. In addition, this disorder may cause more anxiety and distress in the caregiver than the patient. Many caregivers worry that a child’s constipation is a sign of a more serious medical problem. Constipation can be defined as the failure to completely evacuate the rectal vault of stool.

Functional constipation that results from fecal retention is the most common etiology of constipation in childhood, accounting for approximately 97% of cases. The differential diagnosis of constipation is lengthy. The common organic causes of constipation include anal stenosis, imperforate anus, anteriorly displaced anus, presacral teratoma, pelvic tumor or mass, spinal cord abnormalities, cerebral palsy, hypotonia, aganglionosis (Hirschsprung), hypothyroidism, celiac disease, and cystic fibrosis.