Constipation
Everything in the library about constipation — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Evidence & Research
1 item
Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium
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Sarah Ullrich, Kelly Austin, Jeffrey R Avansino, Andrea Badillo, Casey M Calkins, Rachel C Crady, Megan M Durham, Megan K Fuller, Ankur Rana, Ron W Reeder, Rebecca M Rentea, Michael D Rollins, Payam Saadai, K Elizabeth Speck, Richard J Wood
video1:09 · Oct 2024
Case-Based Learning
2 items
The Colorectal Quiz Episode 8: Motility Disorders Part 1
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Motility disorder is a team sport - that's why today, we're talking to our colleagues in Pediatric Gastroenterology, Dr. Anil Darbari from Children's National Hospital and Dr. Kahleb Graham from Cincinnati Children's Hospital. Special guest
podcast14:04 · Mar 2021
Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2
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Bowel management can be difficult on its own but for patients with spinal disorders, it can be exponentially more complex. Today, Dr. Levitt and Dr. Frischer discuss bowel management for this subset of patients and they brought some friends
podcast14:18 · Jul 2021
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium
The Pediatric Colorectal and Pelvic Learning Consortium conducted a multi-center retrospective review from 2017 to 2023 examining the relationship between delayed diagnosis of Hirschsprung disease and postoperative/functional outcomes.
clinicalAlex Halpern0:12 ↗
The study included 679 patients with Hirschsprung disease from 14 different sites.
epidemiologicalAlex Halpern0:23 ↗
Increased age at diagnosis was associated with a greater likelihood of undergoing fecal diversion after initial pull-through procedure.
clinicalAlex Halpern0:29 ↗
Increased age at diagnosis was associated with an increased risk of constipation or incontinence requiring intervention postoperatively.
clinicalAlex Halpern0:39 ↗
No association was found between age at diagnosis and 30-day complication rate after initial pull-through.
clinicalAlex Halpern0:49 ↗
No association was found between age at diagnosis and need for pull-through revision.
clinicalAlex Halpern0:49 ↗
Delayed diagnosis of Hirschsprung disease affects certain postoperative and functional outcomes in patients.
clinicalAlex Halpern0:58 ↗
The Colorectal Quiz Episode 8: Motility Disorders Part 1
Failure of medical management is defined as appropriate treatment with no appropriate response
clinicalKahleb Graham2:51 ↗
Patients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management
clinicalKahleb Graham3:04 ↗
Patients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management
clinicalKahleb Graham3:04 ↗
Failure of retrograde enemas is considered failure of medical management
clinicalKahleb Graham3:21 ↗
Reliance on rectal therapy or retrograde enemas with continued soiling causing significant effect on functioning is considered failure of medical management
clinicalAnil Darbari3:35 ↗
General pediatricians typically prescribe osmotic laxatives (MiraLax, lactulose) and stimulant laxatives (Senna, bisacodyl), but there are other medications GI specialists use that pediatricians are not accustomed to prescribing
clinicalAnil Darbari3:57 ↗
Some children stool every day but don't completely evacuate
clinicalAnil Darbari4:58 ↗
Initial evaluation includes history (triggers, stooling frequency, sensation of complete emptying), physical exam (abdominal distension, palpable stool, rectal exam), and diagnostic imaging (abdominal X-ray, water-soluble contrast enema)
clinicalAnil Darbari4:46 ↗
In patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio
clinicalKahleb Graham5:27 ↗
Water-soluble contrast (not barium) is used for contrast enemas because it helps empty the colon and acts as a cleanout for patients starting new medical therapy
clinicalJason Frischer8:06 ↗
Contrast studies are not great predictors of how patients will respond to medical or surgical management; normal-looking colons may not respond while abnormal-appearing colons may respond well
clinicalJason Frischer7:12 ↗
The rectoanal inhibitory reflex (RAIR) is the response where the internal anal sphincter relaxes when the rectum becomes distended with stool
host_summaryRod9:11 ↗
Anorectal manometry uses a catheter with sensors measuring pressure and a balloon to assess anal sphincter function and its relationship to the rectum
clinicalAnil Darbari9:35 ↗
High pressures on anorectal manometry may suggest underlying inability to relax, causing a functional obstruction
clinicalAnil Darbari10:00 ↗
Patients with Hirschsprung disease have an absent rectoanal inhibitory reflex (RAIR)
clinicalAnil Darbari10:09 ↗
Anorectal manometry provides information about defecation dynamics by having patients bear down, squeeze, and attempt to defecate, comparing sensation to defecate with internal anal sphincter response
clinicalAnil Darbari10:19 ↗
Doctor Levitt states he doesn't know how he survived without anorectal manometry testing
opinionMarc Levitt10:47 ↗
In the past, surgeons did not understand the major role the sphincter played in many patients
opinionJason Frischer10:51 ↗
Colonic motility assessment is critical because in the past, colons or sigmoid colons were resected based on appearance, but patients had motility disorders and did not need resection
clinicalMarc Levitt7:36 ↗
Many dilated colons will respond to treatment
clinicalMarc Levitt7:54 ↗
Anorectal manometry is critical for determining whether a patient needs surgery or resection, as patients with motility disorders do not need surgery
host_summaryRod12:03 ↗
Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2
When a 7 cm appendix is shared between urology and colorectal surgery, the urologist typically takes 6.25 cm leaving only 0.75 cm for colorectal use
clinicalJason Frischer1:17 ↗
Urologists typically take a 70/30 split when sharing the appendix
opinionMarc Levitt1:38 ↗
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