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Gastroenterology445 papers

Chronic constipation

Last edited: 4/13/2026

Overview

Chronic constipation is characterized by infrequent defecation, difficult passage of stools, and/or hard stools persisting for at least several weeks, significantly impacting quality of life 345.

Diagnosis

  • Clinical Criteria: Delay or difficulty in defecation lasting ≥2 weeks 48.
  • Recommended Tests:
    • - Anorectal Manometry: Useful for assessing function 1424. - Colonic Transit Studies: To evaluate transit time 19. - Abdominal Radiographs: Variable use; appropriateness debated 2023.
  • Special Considerations:
    • - Dolichocolon: Common in pediatric patients with constipation 1. - Dyssynergic Defecation: Identified through specialized manometry 33.

    Management

  • First-Line Treatments:
    • - Dietary Fiber: Increased intake through diet or supplements 45. - Lifestyle Modifications: Regular bowel habits, physical activity 545.
  • Pharmacological Treatments:
    • - Osmotic Laxatives: Polyethylene glycol (e.g., Movicol), lactulose 310. - Stimulant Laxatives: Senna (use with caution due to potential risks 2) 10. - Selective Secretory Agents: Lubiprostone for refractory cases 6.
  • Adjunctive Therapies:
    • - Biofeedback Therapy: Effective for dyssynergic defecation 33. - Transanal Irrigation: For refractory cases, especially post-surgical 7.

    Special Populations

  • Pediatrics:
    • - Behavioral Strategies: Combination with pharmacologic treatments 548. - Evaluation: Targeted diagnostic evaluation for refractory cases 4.
  • Elderly:
    • - Polypharmacy Consideration: Address underlying medications contributing to constipation 28. - Non-Pharmacological: Focus on dietary adjustments and physical activity 28.
  • Comorbidities:
    • - Opioid Use: Prophylactic and symptomatic management crucial 930. - Neurological Disorders: Tailored approach considering underlying pathology 40.

    Key Recommendations

  • Initial Management: Increase dietary fiber and implement lifestyle changes (Evidence: Strong 45).
  • Pharmacological Intervention: Use osmotic laxatives as first-line pharmacological treatment for non-responders (Evidence: Moderate 310).
  • Specialized Therapies: Consider biofeedback for patients with dyssynergic defecation (Evidence: Moderate 33).
  • Refractory Cases: Evaluate and consider transanal irrigation for chronic refractory constipation (Evidence: Expert opinion 7).
  • Elderly Patients: Focus on addressing polypharmacy and promoting physical activity (Evidence: Moderate 28).
  • Palliative Care: Implement thorough assessment and prophylactic measures for opioid-induced constipation (Evidence: Moderate 9).

    • References

    1 Simon D, Berens D, Zambrana Valenzuela R, Mohan A, Chakraborty P, Kellermayer T et al.. Dolichocolon is common in pediatric gastroenterology patients with constipation and associated complaints. Journal of pediatric gastroenterology and nutrition 2026. link 2 Zhao J, Chen Y, Du C, Zhang W, Liu W, Chen J et al.. Understanding senna risks: Evidence from the FDA adverse event reporting system. Journal of ethnopharmacology 2026. link 3 Ihara E, Manabe N, Ohkubo H, Ogasawara N, Ogino H, Kakimoto K et al.. Evidence-Based Clinical Guidelines for Chronic Constipation 2023. Digestion 2025. link 4 Kilgore AL, Rogers Boruta MK, Ambartsumyan L, Suarez RG, Patel D, Wood RJ et al.. Evaluation and management of pediatric refractory constipation: Recommendations from the NASPGHAN neurogastroenterology and motility committee. Journal of pediatric gastroenterology and nutrition 2025. link 5 Bloem MN, Keszthelyi D, Benninga MA, Koppen IJN. Pediatric Constipation: What Can We Learn from the Adult Gastroenterologist?. Gastroenterology clinics of North America 2025. link 6 Li Q, Zhang J, Yang C, Dong X, Wang Y. Evaluation of post-market adverse events of lubiprostone: a real-world adverse event analysis from the FAERS database. BMC gastroenterology 2025. link 7 Martellucci J, Falletto E, Ascanelli S, Bondurri A, Borin S, Bottini C et al.. Consensus-driven protocol for transanal irrigation in patients with low anterior resection syndrome and functional constipation. Techniques in coloproctology 2024. link 8 Shah ED, Chey WD. Optimizing Cost-Effective Care for Chronic Constipation in General Gastroenterology Using an Office-Based, Point-Of-Care Test (RED): Cost-Effectiveness and Cost-Minimization Analysis. The American journal of gastroenterology 2024. link 9 Gill V, Badrzadeh H, Williams S, Crouch NM, Buga S, Mooney S et al.. A Rapid Review on the Management of Constipation for Hospice and Palliative Care Patients. Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association 2024. link 10 Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S et al.. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Gastroenterology 2023. link 11 Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S et al.. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. The American journal of gastroenterology 2023. link 12 Rybak A, Martinelli M, Thapar N, Van Wijk MP, Vandenplas Y, Salvatore S et al.. Colonic Function Investigations in Children: Review by the ESPGHAN Motility Working Group. Journal of pediatric gastroenterology and nutrition 2022. link 13 Lindley LC, Keim-Malpass J, Cozad MJ, Mack JW, Svynarenko R, Fornehed MLC et al.. A National Study to Compare Effective Management of Constipation in Children Receiving Concurrent Versus Standard Hospice Care. Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association 2022. link 14 Yates G, Friedmacher F, Cleeve S, Athanasakos E. Anorectal manometry in pediatric settings: A systematic review of 227 studies. Neurogastroenterology and motility 2021. link 15 Al Ali A, Singh R, Filler G, Ramsi M. Abdominal compartment syndrome secondary to chronic constipation in MECP2 duplication syndrome. BMJ case reports 2021. link 16 Tomita T, Kazumori K, Baba K, Zhao X, Chen Y, Miwa H. Impact of chronic constipation on health-related quality of life and work productivity in Japan. Journal of gastroenterology and hepatology 2021. link 17 Wang XJ, Chedid V, Vijayvargiya P, Camilleri M. Clinical Features and Associations of Descending Perineum Syndrome in 300 Adults with Constipation in Gastroenterology Referral Practice. Digestive diseases and sciences 2020. link 18 Dimidi E, Cox C, Scott SM, Whelan K. Probiotic use is common in constipation, but only a minority of general and specialist doctors recommend them and consider there to be an evidence base. Nutrition (Burbank, Los Angeles County, Calif.) 2019. link 19 Bharucha AE, Anderson B, Bouchoucha M. More movement with evaluating colonic transit in humans. Neurogastroenterology and motility 2019. link 20 Kearney R, Edwards T, Bradford M, Klein E. Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation. Pediatric emergency care 2019. link 21 Ghoshal UC, Sachdeva S, Pratap N, Verma A, Karyampudi A, Misra A et al.. Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 2018. link 22 Tack J, Boardman H, Layer P, Schiefke I, Jayne D, Scarpignato C et al.. An expert consensus definition of failure of a treatment to provide adequate relief (F-PAR) for chronic constipation - an international Delphi survey. Alimentary pharmacology & therapeutics 2017. link 23 Beinvogl B, Sabharwal S, McSweeney M, Nurko S. Are We Using Abdominal Radiographs Appropriately in the Management of Pediatric Constipation?. The Journal of pediatrics 2017. link 24 Rodriguez L, Sood M, Di Lorenzo C, Saps M. An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children. Neurogastroenterology and motility 2017. link 25 Madani S, Tsang L, Kamat D. Constipation in Children: A Practical Review. Pediatric annals 2016. link 26 Kuizenga-Wessel S, Mousa HM, Benninga MA, Di Lorenzo C. Lack of Agreement on How to Use Antegrade Enemas in Children. Journal of pediatric gastroenterology and nutrition 2016. link 27 Mallon D, Vernacchio L, Trudell E, Antonelli R, Nurko S, Leichtner AM et al.. Shared care: a quality improvement initiative to optimize primary care management of constipation. Pediatrics 2015. link 28 De Giorgio R, Ruggeri E, Stanghellini V, Eusebi LH, Bazzoli F, Chiarioni G. Chronic constipation in the elderly: a primer for the gastroenterologist. BMC gastroenterology 2015. link 29 Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S et al.. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of pediatric gastroenterology and nutrition 2014. link 30 Tavares CN, Kimbrel JM, Protus BM, Grauer PA. Petroleum jelly (vaseline balls) for the treatment of constipation: a survey of hospice and palliative care practitioners. The American journal of hospice & palliative care 2014. link 31 Hasosah M, Telmesani A, Al-Binali A, Sarkhi A, Alghamdi S, Alquair K et al.. Knowledge and practice styles of pediatricians in Saudi Arabia regarding childhood constipation. Journal of pediatric gastroenterology and nutrition 2013. link 32 Tarumi Y, Wilson MP, Szafran O, Spooner GR. Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. Journal of pain and symptom management 2013. link 33 Koh D, Lim JF, Quah HM, Tang CL. Biofeedback is an effective treatment for patients with dyssynergic defaecation. Singapore medical journal 2012. link 34 Clark K, Currow DC. Assessing constipation in palliative care within a gastroenterology framework. Palliative medicine 2012. link 35 Fritz D, Pitlick M. Evidence about the prevention and management of constipation: implications for comfort part 1. Home healthcare nurse 2012. link 36 Fang AC, Carnell J, Stein JC. Constipation in a 7-year-old boy: congenital band causing a strangulated small bowel and pulseless electrical activity. The Journal of emergency medicine 2012. link 37 Philichi L, Yuwono M. Primary care: constipation and encopresis treatment strategies and reasons to refer. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2010. link 38 Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options. Clinical interventions in aging 2010. link 39 Noguera A, Centeno C, Librada S, Nabal M. Screening for constipation in palliative care patients. Journal of palliative medicine 2009. link 40 Philichi L. When the going gets tough: pediatric constipation and encopresis. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2008. link 41 McCrea GL, Miaskowski C, Stotts NA, Macera L, Varma MG. Pathophysiology of constipation in the older adult. World journal of gastroenterology 2008. link 42 Iantorno G, Cinquetti M, Mazzocchi A, Morelli A, Bassotti G. Audit of constipation in a gastroenterology referral center. Digestive diseases and sciences 2007. link 43 Ginsberg DA, Phillips SE, Wallace J, Josephson KL. Evaluating and managing constipation in the elderly. Urologic nursing 2007. link 44 Focht DR, Baker RC, Heubi JE, Moyer MS. Variability in the management of childhood constipation. Clinical pediatrics 2006. link 45 Bleser SD. Chronic constipation: let symptom type and severity direct treatment. The Journal of family practice 2006. link 46 . Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition 2006. link 47 Sullivan PB, Burnett CA, Juszczak E. Parent satisfaction in a nurse led clinic compared with a paediatric gastroenterology clinic for the management of intractable, functional constipation. Archives of disease in childhood 2006. link 48 . Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition 2006. link 49 Lacy BE, Brunton SA. Partnering with gastroenterologists to evaluate patients with chronic constipation. MedGenMed : Medscape general medicine 2005. link 50 Wirz S, Klaschik E. Management of constipation in palliative care patients undergoing opioid therapy: is polyethylene glycol an option?. The American journal of hospice & palliative care 2005. link 51 Coughlin EC. Assessment and management of pediatric constipation in primary care. Pediatric nursing 2003. link 52 Klaschik E, Nauck F, Ostgathe C. Constipation--modern laxative therapy. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2003. link 53 Preece J. Introducing abdominal massage in palliative care for the relief of constipation. Complementary therapies in nursing & midwifery 2002. link 54 De Caluwé D, Yoneda A, Akl U, Puri P. Internal anal sphincter achalasia: outcome after internal sphincter myectomy. Journal of pediatric surgery 2001. link 55 Locke GR, Pemberton JH, Phillips SF. AGA technical review on constipation. American Gastroenterological Association. Gastroenterology 2000. link 56 Kinnunen O. Study of constipation in a geriatric hospital, day hospital, old people's home and at home. Aging (Milan, Italy) 1991. link 57 Chaussade S, Khyari A, Roche H, Garret M, Gaudric M, Couturier D et al.. Determination of total and segmental colonic transit time in constipated patients. Results in 91 patients with a new simplified method. Digestive diseases and sciences 1989. link 58 Leon SH, Krishnamurthy S, Schuffler MD. Subtotal colectomy for severe idiopathic constipation. A follow-up study of 13 patients. Digestive diseases and sciences 1987. link 59 O'Regan S, Yazbeck S. Constipation: a cause of enuresis, urinary tract infection and vesico-ureteral reflux in children. Medical hypotheses 1985. link90100-8) 60 Smith B, Grace RH, Todd IP. Organic constipation in adults. The British journal of surgery 1977. link

    Original source

    1. [1]
      Dolichocolon is common in pediatric gastroenterology patients with constipation and associated complaints. — Simon D, Berens D, Zambrana Valenzuela R, Mohan A, Chakraborty P, Kellermayer T et al. Journal of pediatric gastroenterology and nutrition (2026)
    2. [2]
      Understanding senna risks: Evidence from the FDA adverse event reporting system. — Zhao J, Chen Y, Du C, Zhang W, Liu W, Chen J et al. Journal of ethnopharmacology (2026)
    3. [3]
      Evidence-Based Clinical Guidelines for Chronic Constipation 2023. — Ihara E, Manabe N, Ohkubo H, Ogasawara N, Ogino H, Kakimoto K et al. Digestion (2025)
    4. [4]
      Evaluation and management of pediatric refractory constipation: Recommendations from the NASPGHAN neurogastroenterology and motility committee. — Kilgore AL, Rogers Boruta MK, Ambartsumyan L, Suarez RG, Patel D, Wood RJ et al. Journal of pediatric gastroenterology and nutrition (2025)
    5. [5]
      Pediatric Constipation: What Can We Learn from the Adult Gastroenterologist? — Bloem MN, Keszthelyi D, Benninga MA, Koppen IJN Gastroenterology clinics of North America (2025)
    6. [6]
      Evaluation of post-market adverse events of lubiprostone: a real-world adverse event analysis from the FAERS database. — Li Q, Zhang J, Yang C, Dong X, Wang Y BMC gastroenterology (2025)
    7. [7]
      Consensus-driven protocol for transanal irrigation in patients with low anterior resection syndrome and functional constipation. — Martellucci J, Falletto E, Ascanelli S, Bondurri A, Borin S, Bottini C et al. Techniques in coloproctology (2024)
    8. [8]
      Optimizing Cost-Effective Care for Chronic Constipation in General Gastroenterology Using an Office-Based, Point-Of-Care Test (RED): Cost-Effectiveness and Cost-Minimization Analysis. — Shah ED, Chey WD The American journal of gastroenterology (2024)
    9. [9]
      A Rapid Review on the Management of Constipation for Hospice and Palliative Care Patients. — Gill V, Badrzadeh H, Williams S, Crouch NM, Buga S, Mooney S et al. Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association (2024)
    10. [10]
      American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. — Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S et al. Gastroenterology (2023)
    11. [11]
      American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. — Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S et al. The American journal of gastroenterology (2023)
    12. [12]
      Colonic Function Investigations in Children: Review by the ESPGHAN Motility Working Group. — Rybak A, Martinelli M, Thapar N, Van Wijk MP, Vandenplas Y, Salvatore S et al. Journal of pediatric gastroenterology and nutrition (2022)
    13. [13]
      A National Study to Compare Effective Management of Constipation in Children Receiving Concurrent Versus Standard Hospice Care. — Lindley LC, Keim-Malpass J, Cozad MJ, Mack JW, Svynarenko R, Fornehed MLC et al. Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association (2022)
    14. [14]
      Anorectal manometry in pediatric settings: A systematic review of 227 studies. — Yates G, Friedmacher F, Cleeve S, Athanasakos E Neurogastroenterology and motility (2021)
    15. [15]
      Abdominal compartment syndrome secondary to chronic constipation in MECP2 duplication syndrome. — Al Ali A, Singh R, Filler G, Ramsi M BMJ case reports (2021)
    16. [16]
      Impact of chronic constipation on health-related quality of life and work productivity in Japan. — Tomita T, Kazumori K, Baba K, Zhao X, Chen Y, Miwa H Journal of gastroenterology and hepatology (2021)
    17. [17]
      Clinical Features and Associations of Descending Perineum Syndrome in 300 Adults with Constipation in Gastroenterology Referral Practice. — Wang XJ, Chedid V, Vijayvargiya P, Camilleri M Digestive diseases and sciences (2020)
    18. [18]
      Probiotic use is common in constipation, but only a minority of general and specialist doctors recommend them and consider there to be an evidence base. — Dimidi E, Cox C, Scott SM, Whelan K Nutrition (Burbank, Los Angeles County, Calif.) (2019)
    19. [19]
      More movement with evaluating colonic transit in humans. — Bharucha AE, Anderson B, Bouchoucha M Neurogastroenterology and motility (2019)
    20. [20]
      Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation. — Kearney R, Edwards T, Bradford M, Klein E Pediatric emergency care (2019)
    21. [21]
      Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. — Ghoshal UC, Sachdeva S, Pratap N, Verma A, Karyampudi A, Misra A et al. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (2018)
    22. [22]
      An expert consensus definition of failure of a treatment to provide adequate relief (F-PAR) for chronic constipation - an international Delphi survey. — Tack J, Boardman H, Layer P, Schiefke I, Jayne D, Scarpignato C et al. Alimentary pharmacology & therapeutics (2017)
    23. [23]
      Are We Using Abdominal Radiographs Appropriately in the Management of Pediatric Constipation? — Beinvogl B, Sabharwal S, McSweeney M, Nurko S The Journal of pediatrics (2017)
    24. [24]
      An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children. — Rodriguez L, Sood M, Di Lorenzo C, Saps M Neurogastroenterology and motility (2017)
    25. [25]
      Constipation in Children: A Practical Review. — Madani S, Tsang L, Kamat D Pediatric annals (2016)
    26. [26]
      Lack of Agreement on How to Use Antegrade Enemas in Children. — Kuizenga-Wessel S, Mousa HM, Benninga MA, Di Lorenzo C Journal of pediatric gastroenterology and nutrition (2016)
    27. [27]
      Shared care: a quality improvement initiative to optimize primary care management of constipation. — Mallon D, Vernacchio L, Trudell E, Antonelli R, Nurko S, Leichtner AM et al. Pediatrics (2015)
    28. [28]
      Chronic constipation in the elderly: a primer for the gastroenterologist. — De Giorgio R, Ruggeri E, Stanghellini V, Eusebi LH, Bazzoli F, Chiarioni G BMC gastroenterology (2015)
    29. [29]
      Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. — Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S et al. Journal of pediatric gastroenterology and nutrition (2014)
    30. [30]
      Petroleum jelly (vaseline balls) for the treatment of constipation: a survey of hospice and palliative care practitioners. — Tavares CN, Kimbrel JM, Protus BM, Grauer PA The American journal of hospice & palliative care (2014)
    31. [31]
      Knowledge and practice styles of pediatricians in Saudi Arabia regarding childhood constipation. — Hasosah M, Telmesani A, Al-Binali A, Sarkhi A, Alghamdi S, Alquair K et al. Journal of pediatric gastroenterology and nutrition (2013)
    32. [32]
      Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. — Tarumi Y, Wilson MP, Szafran O, Spooner GR Journal of pain and symptom management (2013)
    33. [33]
      Biofeedback is an effective treatment for patients with dyssynergic defaecation. — Koh D, Lim JF, Quah HM, Tang CL Singapore medical journal (2012)
    34. [34]
      Assessing constipation in palliative care within a gastroenterology framework. — Clark K, Currow DC Palliative medicine (2012)
    35. [35]
      Evidence about the prevention and management of constipation: implications for comfort part 1. — Fritz D, Pitlick M Home healthcare nurse (2012)
    36. [36]
      Constipation in a 7-year-old boy: congenital band causing a strangulated small bowel and pulseless electrical activity. — Fang AC, Carnell J, Stein JC The Journal of emergency medicine (2012)
    37. [37]
      Primary care: constipation and encopresis treatment strategies and reasons to refer. — Philichi L, Yuwono M Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates (2010)
    38. [38]
      Update on the management of constipation in the elderly: new treatment options. — Rao SS, Go JT Clinical interventions in aging (2010)
    39. [39]
      Screening for constipation in palliative care patients. — Noguera A, Centeno C, Librada S, Nabal M Journal of palliative medicine (2009)
    40. [40]
      When the going gets tough: pediatric constipation and encopresis. — Philichi L Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates (2008)
    41. [41]
      Pathophysiology of constipation in the older adult. — McCrea GL, Miaskowski C, Stotts NA, Macera L, Varma MG World journal of gastroenterology (2008)
    42. [42]
      Audit of constipation in a gastroenterology referral center. — Iantorno G, Cinquetti M, Mazzocchi A, Morelli A, Bassotti G Digestive diseases and sciences (2007)
    43. [43]
      Evaluating and managing constipation in the elderly. — Ginsberg DA, Phillips SE, Wallace J, Josephson KL Urologic nursing (2007)
    44. [44]
      Variability in the management of childhood constipation. — Focht DR, Baker RC, Heubi JE, Moyer MS Clinical pediatrics (2006)
    45. [45]
      Chronic constipation: let symptom type and severity direct treatment. — Bleser SD The Journal of family practice (2006)
    46. [46]
      Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition (2006)
    47. [47]
      Parent satisfaction in a nurse led clinic compared with a paediatric gastroenterology clinic for the management of intractable, functional constipation. — Sullivan PB, Burnett CA, Juszczak E Archives of disease in childhood (2006)
    48. [48]
      Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition (2006)
    49. [49]
      Partnering with gastroenterologists to evaluate patients with chronic constipation. — Lacy BE, Brunton SA MedGenMed : Medscape general medicine (2005)
    50. [50]
      Management of constipation in palliative care patients undergoing opioid therapy: is polyethylene glycol an option? — Wirz S, Klaschik E The American journal of hospice & palliative care (2005)
    51. [51]
      Assessment and management of pediatric constipation in primary care. — Coughlin EC Pediatric nursing (2003)
    52. [52]
      Constipation--modern laxative therapy. — Klaschik E, Nauck F, Ostgathe C Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2003)
    53. [53]
      Introducing abdominal massage in palliative care for the relief of constipation. — Preece J Complementary therapies in nursing & midwifery (2002)
    54. [54]
      Internal anal sphincter achalasia: outcome after internal sphincter myectomy. — De Caluwé D, Yoneda A, Akl U, Puri P Journal of pediatric surgery (2001)
    55. [55]
      AGA technical review on constipation. American Gastroenterological Association. — Locke GR, Pemberton JH, Phillips SF Gastroenterology (2000)
    56. [56]
      Study of constipation in a geriatric hospital, day hospital, old people's home and at home. — Kinnunen O Aging (Milan, Italy) (1991)
    57. [57]
      Determination of total and segmental colonic transit time in constipated patients. Results in 91 patients with a new simplified method. — Chaussade S, Khyari A, Roche H, Garret M, Gaudric M, Couturier D et al. Digestive diseases and sciences (1989)
    58. [58]
      Subtotal colectomy for severe idiopathic constipation. A follow-up study of 13 patients. — Leon SH, Krishnamurthy S, Schuffler MD Digestive diseases and sciences (1987)
    59. [59]
      Constipation: a cause of enuresis, urinary tract infection and vesico-ureteral reflux in children. — O'Regan S, Yazbeck S Medical hypotheses (1985)
    60. [60]
      Organic constipation in adults. — Smith B, Grace RH, Todd IP The British journal of surgery (1977)
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