| History |
Age of onset of symptoms |
| Age at first passage of meconium |
| Previous surgery |
| Frequency, consistency of stools |
- Withholding behavior
- Success or failure of toilet training
- Smearing of stool in underwear
- Dancing or standing on toes before a bowel movement
- History of clogging the toilet
|
- Symptoms
- Abdominal pain
- Nausea, vomiting
- Pain, bleeding when passing stools
- Fecal or urinary incontinence — if present, whether it is also nocturnal
- Weakness
|
- Dietary history
- Changes in appetite
- Fiber intake — fruits, vegetables, salad, grains, fiber supplements
- Fluid intake
- Verify proper formula preparation for infants
|
- Growth and development
- Normal height, weight gain, and gross motor milestones supports functional constipation
|
- Treatment, medications
- Previous, present treatment, including over-the-counter meds or home remedies
|
- Psychosocial history
- Disruption of child or family life and activities, interaction with peers, and temperament
- Activity level — sports, video games, computer, TV
|
| Physical Exam |
Review growth curves |
- Abdomen
- Distension, fecal mass, tenderness
|
- Neurologic exam of lower extremities
|
- Rectal exam
- Discuss with fellow/attending
- Review procedure, obtain verbal consent, Chaperone Policy
- Cover child to respect privacy position on lateral side with legs curled up, use lubricant
- Can ask child to “bear down” to aid with exam
|
- Inspect
- Lumbosacral and gluteal region for:
- Asymmetry
- Flattening of gluteal muscles evidence of sacral agenesis
- Discolored skin, naevi or sinus, hairy patch, lipoma
- Central pit, dimple and can’t see the bottom
- Position of anal opening
- Anal wink
- Perianal disease
- Stricture, skin tags, fistula, fissures
- Normal
- No stool in rectum; the rectum not gripping the finger tightly
- Abnormal
- Finger gripped by rectum tightly; or hard mass of stool on the rectum
- Or explosive evacuation of stool and air from rectum upon withdrawal
of examining finger
|