Functional constipation and stool withholding in children

What it is

Chronic constipation is defined as three or fewer bowel movements per week. For functional constipation what is written is three points. 1) Two or more of the following, in at least 25% occasions: fewer than 3 defecations per week; hard stools and straining; sensation of anorectal obstruction; sensation of incomplete evacuations; and manual maneuvers to defecate. 2) Loose stools are rarely present without laxatives. 3) Insufficient criteria for IBS. The remark under them is that the criteria are fulfilled for the last 3 months with onset at least 6 months prior diagnosis.

In children the same disorder is common enough to shape what a child with rectal bleeding is likely to have. Classical haemorroidal disease is relatively rare in children, and painful bright red rectal bleeding is much more common, since constipation is a relatively common childhood disorder: the hard stool causes a tear of the ano-rectal mucosa, and a fissure follows.

How it presents

The pain from the fissure must be addressed promptly, or the child will delay defecation and the fissure will worsen. That is the cycle the whole topic turns on: hard stool, tear, pain, delay, and a worse tear again.