Constipation




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		WARNING, WARNING, WARNING; This section is for my Tufts University and University of the Philippines medical students. If you are a "worrier" type or a very anxious parent, please talk to your clinician about your child's problem or symptoms, rather than reading this differential diagnosis listing. CAUSES OF CONSTIPATION Here are some important causes of constipation: Intestinal obstruction, Hirschsprungs disease, Hypothyroidism, Infant Botulism, Lead poisoning, Tumors, Hyperparathyroidism, Hypercalcemia, and Tethered cord syndrome. However, these are not common causes. The more common ones are: Milk allergy, inadequate intake of fluids or fibers, and Anal fissure. From: Signs & Symptoms In Pediatrics 2nd Edition, page 392, Tunnessen, Jr PHYSIOLOGIC CAUSES Cow's Milk Allergy Low Dietary Roughage Breast Feeding Febrile Illness How Weather Immobility Anorexia Nervosa ENDOCRINE & METABOLIS CAUSES Hypothyroidism Diabetes Mellitus Pheochromocytoma Hypokalemia Hypercalcemia or Hypocalemia Lipid Storage Disease Amyloidosis Conditions Associated with Polyuria Acute Intermittent Porphyria VOLUNTARY WITHOLDING Megacolon with or without Encopresis Painful defecations (Anal Fissure, Perianal Dermatitis, Hemorrhoids) Intentional Witholding Improper Toilet Training Emotional Disturbance Severe Mental Retardation Depression NEUROLOGIC CAUSES Hirschsprung Disease (Congenital Megacolon) Intestinal Pseudo-Obstruction Cerebral Palsy Myelomeningocele Spinal Cord Injury Sacral Agenesis Diatematomyelia Spinal Dysraphism Muscular Weakness Acquired Postganglionic Cholinergic Dysautonomia Neurofibromatosis DELAYED PASSAGE OF MECONIUM Intestinal Obstruction Meconium Ileus Hirshsprung Disease Meconium Plug Functional Ileus Small Left Colon Syndrome Drugs Administered to Mother Hypothyroidism OTHER CAUSES Infant Botulism Lead :Poisoning Tetanus Drugs Salmonellosis Anal or Rectal Stenosis Anteriorally Placed Anus Dolichocolon Appendicitis Celiac Disease Scheroderma Chagas Disease Viral Hepatitis Meconium Ileus Equivalent Differential Diagnosis of Constipation from PEDIATRIC COMPLAINTS AND DIAGNOSTIC DILEMMAS, by Shah & Ludwig, 2004 Causes of Constipation Functional Functional fecal retention, Lack of bulk and fiber in the diet, Protracted vomiting, Irritable bowel syndrome Obstructive Adenocarcinoma, Pelvic tumor, mass, or pregnancy, Meconium ileus (cystic fibrosis), Anterior ectopic anus, Congenital or acquired anal ring stenosis, Small left colon, Rectal of sigmoid stricture Endocrine & Metabolic Hypothyroidism, Hyperparathyroidism, Idiopathic hypercalcemia, Hypokalemia, Pheochromocytoma, Diabetes, Renal tubular acidosis, Vitamin D intoxication, Amyloidosis, Collagen-vascular (scleroderma, lupus, dermatomyositis), Visceral myopathy, Congenital pseudo-obstruction, Multiple endocrine adenoma, Porphyria, Graft versus host disease Neurologic Aganglionosis (Hirschsprung's disease), Neuronal dysplasia (hyperganglionosis), Hypoganglionosis (Chagas disease), Familial dysautonomia, Hypotonia syndromes, Spina bifida occulta, Myelomeningocele, Paraplegia, Cauda equina tumor, Tethered cord syndrome Functional Functional fecal retention, Protracted vomiting, Lack of bulk in diet, Irritable bowel syndrome Medicinal** Laxative abuse, Diuretics, Tricyclic antidepressants, Narcotics, Aluminum antacids, Vincristine, Calcium channel blockers, Iron overload, Lead poisoning End Belly Pain Air Leaks From Lungs Acute Crying Back Pain Bed Wetting Big Lymph Node Big Spleen Blood in Urine Chronic Diarrhea Chest Pain Cough Coughing Up Blood Constipation Droopy Eye Enlarged Glands Eye Swelling Excessive Thrist Facial Paralysis Fainting Spell Feeding Problem GI Bleeding Headache Head Tilt Hives High ESR Hoarseness Joint Pain Limp Leg Pain Muscle Weakness Noisy Breathing Nose Bleeding Nose Obstruction Pyuria Recurrent Infection Red Green Urine Ringing in the Ears Scrotal Swelling Seizures Stiff Neck Swelling of the Parotic Gland Toe Walking Toeing In Toeing Out Unequal Pupils Vomiting Wheezing Leo Leonidas, MD, FAAP Assistant Clinical Professor in Pediatrics Tufts University School of Medicine, Boston Attending Pediatrician Eastern Maine Medical Center, Bangor

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