A surprising increase in the number of children with severe constipation has prompted Johns Hopkins Children's Center in Baltimore, MD to launch a multidisciplinary clinic to deal with what gastroenterologists there say is a trend.
Center officials say they are seeing children with the condition on a daily basis, with a 30% increase in related visits between 2008 and 2009.
"The reality is that too many children are either not treated at all, start treatment too late or are treated inadequately, leading to persistent, severe and chronic constipation," says Maria Oliva-Hemker MD, director of pediatric gastroenterology and nutrition at the center.
The clinic, which began this month, operates several days a month and sees five to six patients per day.
Gastroenterologists and other team members say they're seeing children with much more than mild constipation. The condition is easy to miss or ignore, but can have lifelong complications, resulting in more serious medical conditions in adulthood, including urinary tract infections, fecal incontinence, nausea, vomiting, headaches, abdominal distension, and flatulence.
Research demonstrates that children with constipation have a worse quality of life than children with more permanent medical conditions including inflammatory bowel disease and gastro-esophageal reflux.
Mathews says that the program is designed to help parents create a toilet routine for their child and to complement the medical treatment of the child.
"Over time, the goal is to gradually fade out the parental involvement and increase the child's independent toileting," Mathews says.
Oliva-Hemker says that the problem is exacerbated by the notion that constipation usually goes away on its own, children will outgrow it or that a change in diet alone is enough to restore normal bowel movement.
"Severe constipation needs to be treated early and aggressively," she says. "And no amount of fiber or prune juice will help a child with serious chronic constipation."
Lisa L. Seaman, pediatric nurse practitioner in the Pediatric Gastroenterology and Nutrition program at Johns Hopkins, says the majority of the patients are school age children and toddlers.
"For the toddler population, we try to eliminate the fear of defecation from painful defecation that they experience from constipation," Seaman says. "School age children are more prone to constipation when they are exposed to a bathroom that is less private than the one they have utilized at home. Any child with fear of defecation, pain with defecation, or embarrassment will expose them to be at a higher risk for constipation, at any age."
Seaman says much of the increase in the problem is seen in children who are obese. "Our society's higher fat and carbohydrate diet only exacerbates constipation."
Constipation in children is defined as having fewer than three bowel movements a week for three, not necessarily consecutive, months in a year. Symptoms include abdominal bloating, feeling of fullness, straining at the toilet, lumpy or hard stools or small pellet-like stools accompanied by incomplete emptying of the bowel.
The formation of this special clinic is actually a revitalization of one that used to exist at Johns Hopkins, without the behavioral component, but faded away for reasons unclear.