Constipation is a very common frustration for children, parents, and physicians. It is reported to account for nearly 5% of all outpatient visits to pediatric clinics and more than 25% of all referrals to pediatric gastroenterologists. Painful defecation and encopresis (involuntary passage of stool from the anus) usually are the first manifestations noted. Constipation generally is defined by the hard nature of the stool, the pain associated with its passage, or the failure to pass three stools per week. It would be preferable to define constipation as the failure to evacuate the lower colon completely with a bowel movement. This allows the parents and physician to realize that a child who has three small stools daily may not yet have evacuated the colon, while a child who has two large soft stools a week may not be constipated.

The frequency of stools in most children decreases from a mean of...

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