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Constipation as cause of stomach pain overlooked
NEW YORK (Reuters Health) - Parents and doctors may overlook constipation as the cause of acute stomach pain in children, but constipation may account for most of the abdominal pain among kids, a study shows.
Nearly half of the 83 children aged 4 to 18 years who were treated for abdominal pain at The Children's Hospital of Iowa during the first half of 2004 were constipated: 35 percent had chronic constipation (lasting for more than 2 months) while 13 percent had acute constipation.
Dr. Vera Loening-Baucke, from the University of Iowa, in Iowa City and colleagues identified these children among the 962 otherwise healthy children examined during the first six months of 2004. Overall, 12 percent of the girls, compared with 5 percent of the boys complained of acute abdominal pain, they report in The Journal of Pediatrics.
Prior to examination, 66 percent of the children had been complaining of pain for 30 minutes to 3 days; another 23 percent had pain lasting from 3 to 7 days; and the remaining children had pain over the previous 7 days to 5 weeks.
Despite these children meeting criteria for constipation, including less than 3 stools per week, one or more episode of fecal incontinence per week, large stools, or painful defecation, neither the parents nor the children associated the abdominal pain with constipation.
Parents are frequently unaware of their child's bowel habits, Loening-Baucke said, and may count soiling episodes as bowel movements.
Physicians may likewise overlook constipation as the cause of abdominal pain, Loening-Baucke told Reuters Health, "by just asking for normal or abnormal bowel habits and not for other symptoms which define constipation."
No cause for the stomach pain was found in 19 percent of the children but, in all of these children, pain resolved spontaneously. They attributed another 7, 14, and 8 percent of the acute abdominal pain, respectively, to colic, infection, and other causes, while another 2 percent required surgery due to appendicitis and hernia.
"A rectal examination has the potential to contribute clinically important information in children with acute abdominal pain of undetermined etiology," Loening-Baucke said, particularly if the history does not indicate the cause.
SOURCE: The Journal of Pediatrics, December 2007
Reuters Health