Table 3 highlights the major diagnostic steps recommended in the guidelines based on the symptoms presented, and Table 4 highlights the specific recommendations against the use of imaging and other tests.
Unless the history and physical exam suggest the possibility of an underlying disorder, x-rays and other imaging or invasive tests are not recommended, emphasizes Nurko, citing the latest evidence that recommend against the use of x-rays to “rule in” constipation and the evidence to support the lack of utility of abdominal x-rays for diagnosis.3,9,10
If the history and physical exam suggest an underlying condition, specific additional tests for suspected conditions are recommended (Table 5).
Nurko emphasizes that most children with constipation do not have an underlying organic disorder. As such, diagnosis based on history and physical exam is sufficient for most cases of functional constipation, he says.
Key message: Most cases of constipation in children can be diagnosed by history and physical exam alone and do not require additional testing.