Study suggests that physicians should do a simple rectal examination for constipation when trying to determine the cause of abdominal pain in children

A new study led by a University of Iowa researcher showed that acute and chronic constipation together accounted for nearly half of all cases of acute abdominal pain in children treated at one hospital.

The study also suggests that physicians should do a simple rectal examination for constipation when trying to determine the cause of abdominal pain in children. The findings, which were based on medical records of 962 children ages 4 to nearly 18, appear in the December issue of the Journal of Pediatrics.

Earlier studies have shown that constipation can contribute to abdominal pain in children, but no specific recommendations for diagnosing this contributing factor were made, said Vera Loening-Baucke, M.D., professor of pediatrics at the University of Iowa Carver College of Medicine and the study's lead investigator.

"Constipation can be overlooked as the cause of severe or intermittent abdominal pain, as a reporting of symptoms alone does not always establish that a child has constipation," she said. "Our study helps to show that constipation frequently causes acute abdominal pain and that a physician should not just ask the parent if the child is constipated because the parent may have not been able to see all the signs of this condition."

Constipation signs include fewer than three bowel movements per week, one or more episodes of stool incontinence per week, passing of stools so large that they obstruct the toilet, retentive posturing (withholding behavior) and painful defecation.

"The doctor should perform an abdominal examination and a rectal examination to see if the child is retaining stool," said Loening, who sees patients at University of Iowa Children's Hospital.

Loening said that some doctors shy away from the rectal examination, which involves digitally checking for impacted stool in the lower colon, because they believe it may cause a child mental or physical discomfort. However, the test can be performed safely and explained to children so that they understand its purpose.

"It's important for doctors to do a thorough evaluation for abdominal pain, as there are many causes. In addition to constipation, having a cold or sore throat can also cause abdominal pain, for example," Loening-Baucke said.

The study found that 83 (9 percent) of 962 children who had received at least one "well-child" visit during a six-month period in 2004 at University of Iowa Children's Hospital or University of Iowa Hospitals and Clinics reported acute abdominal pain at that visit or another clinic or emergency visit. Significantly more girls (12 percent of the 962) reported such pain, compared to only 5 percent of boys.

Of the 83 children with acute abdominal pain, 72 were seen in a primary care clinic and 11 were examined after hours in the emergency department. Together, acute constipation (lasting eight or fewer weeks) and chronic constipation (lasting eight or more weeks) accounted for 48 percent of the cases (40 children), making it the most common cause of the pain.

Only 2 percent of the children with pain had a surgical condition such as appendicitis. In addition, doctors could not determine causes for 19 percent of the patients with pain.

While most of the patients reviewed in the study were Caucasian, individuals from all other races were included.