Constipation and the way out

<h3>Constipation as a diagnosis can be dangerous, mainly because it is a powerful anchor in our medical decision-making.</h3> <p>Chances are, you’d be right to chalk up the pain to <em>functional constipation</em> — 90% of pediatric constipation is functional, multifactorial, and mostly benign — as long as it is addressed.</p> <p>We’re not here for “<em>chances are</em>“; we’re here for “<em>why isn’t it?</em>“</p> <p><em>Ask yourself, could it be:</em></p> <p>Anatomic <em>malformations</em><em>:</em> anal stenosis, anterior displaced anus, sacral hematoma</p> <p>Metabolic: hypothyroidism, hypercalcemia, hypokalemia, cystic fibrosis, diabetes mellitus, gluten enteropathy</p> <p>Neuropathic: spinal cord abnormalities, trauma, tethered cord</p> <p>Neuromuscular: Hirschprung disease, intestinal neuronal dysplasia, myopathies, Down syndrome, prune belly syndrome</p> <p>Connective tissue disorders: scleroderma, SLE, Ehlers-Danlos syndrome</p> <p>Drugs: opioids, antacids, antihypertensives, anticholinergics, antidepressants, sympathomimetics</p> <p>Ingestions: heavy metals, vitamin D overload, botulism, cow’s milk protein intolerance</p> <p> </p> <h3>Red Flags</h3> <p>Failure to thrive</p> <p>Abdominal distention</p> <p>Lack of lumbosacral curve</p> <p>Midline pigmentation abnormalities of the lower spine</p> <p>Tight, empty rectum in presence of a palpable fecal mass</p> <p>Gush of fluid or air from rectum on withdrawal of finger</p> <p>Absent anal wink</p> <p> </p> <img class="wp-image-2259" src= "https://i1.wp.com/pemplaybook.org/wp-content/uploads/2021/02/Constipation-1.png?resize=800%2C600&ssl=1" sizes="(max-width: 800px) 100vw, 800px" srcset= "https://i1.wp.com/pemplaybook.org/wp-content/uploads/2021/02/Constipation-1.png?w=960&ssl=1 960w, https://i1.wp.com/pemplaybook.org/wp-content/uploads/2021/02/Constipation-1.png?resize=300%2C225&ssl=1 300w, https://i1.wp.com/pemplaybook.org/wp-content/uploads/2021/02/Constipation-1.png?resize=768%2C576&ssl=1 768w" alt="" width="760" height="570" data-attachment-id="2259" da