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Constipation — DCH MCQ

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ModerateCommon childhood illnessesConstipationDCH

A 5-year-old boy has a 3-month history of intermittent abdominal pain and frequent soiling of his underwear. He opens his bowels twice weekly and passes large, hard, painful stools. He is growing normally and has no vomiting, rectal bleeding or systemic symptoms. His abdomen is soft, with a palpable faecal mass and no guarding or rebound tenderness. What is the most likely diagnosis?

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Correct answer: D — Idiopathic constipation with faecal impaction and overflow soiling

The diagnosis is idiopathic constipation with faecal impaction and overflow soiling. Fewer than three bowel movements per week, large painful stools and abdominal pain are characteristic of childhood constipation. The palpable faecal mass, together with soiling, indicates impaction with softer stool leaking around retained faeces; the soiling is involuntary and should not be blamed on the child. Inflammatory bowel disease would more typically cause diarrhoea, rectal bleeding, weight loss or systemic illness. Coeliac disease may cause altered bowel habits and faltering growth but does not best explain this classic pattern. Gastroenteritis is acute and diarrhoeal, while appendicitis usually causes progressive pain, tenderness and often guarding rather than chronic infrequent stools.

Reference: National Institute for Health and Care Excellence. Constipation in children and young people: diagnosis and management. NICE guideline CG99, recommendations 1.1.1 and 1.4.1; updated 2017. https://www.nice.org.uk/guidance/cg99/chapter/Recommendations