• Childhood constipation is typically characterized by infrequent bowel evacuations, large stools, and difficult or painful defecation.
  • Symptoms may result from low fiber, poor nutrient, and/or insufficient water intake, which leads to excessive hardening of the stool. This often starts as an acute problem but can progress to fecal impaction and chronic constipation.
  • Particularly in young children, any cause of painful defecation may provoke active withholding. Withholding may worsen the constipation and lead to a vicious cycle.
  • Duration of constipation and amount of stool burden may depend on capacity of the child's rectum, the degree of megarectum, and other factors including rectal sensory function.
  • After fecal disimpaction, maintenance stool softeners are essential and are often required for many months or years to reduce relapse risk.

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