The purpose of these pages is to describe the characteristics and treatment for functional pediatric defecation disorders that prompt parents to bring their child to the doctor for constipation and/or stool incontinence:
- infant dyschezia,
- functional constipation,
- and non-retentive fecal soiling.
What is a functional disorder?
A functional disorder refers to a condition where the abnormality is an altered physiological function (the way the body works) rather than an abnormality that is characterized by tissue damage or inflammation.
In this context, “functional” means that the symptoms occur within the expected range of the body’s behavior. (Examples: Shivering after a cold swim is a symptom, but not due to disease; a runner’s leg cramp is very painful, but the muscle is healthy.)
Genetics, diet, social habits, convenience, cultural beliefs, relationships within the family, and timing of daily activities influence how often a child has a bowel movement.
In healthy children, the number of bowel movements (BMs) changes with age and diet. Infants average four BMs each day during the first week of life. There is a decline to about two BMs each day by age two, and one BM each day by age four. Healthy breast-fed infants may have no BMs for weeks.
New parents may want to have the symptom checked by a pediatrician, but should be reassured by the absence of symptoms such as vomiting, fever, failure to gain weight, or abdominal distention. Any of these symptoms, along with the infrequent passage of stool, should prompt a visit to the pediatrician.
Defecation Disorders: Constipation
Constipation is defined by a reduced stool frequency, or by painful BMs, even when the stool frequency is not reduced. Constipation accounts for 3% of visits to the pediatrician, and about 25% of visits to the pediatric gastroenterologist. Constipation is a problem for about 1 in 6 children at some time. Boys and girls are equally affected.
Adapted from IFFGD Publication #810 by Paul E. Hyman, MD, Professor of Pediatrics, Louisiana State University; Chief Pediatric Gastroenterology, Children’s Hospital, New Orleans, LA.