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Constipation — MRCPCH FOP MCQ

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ModerateGastroenterologyConstipationMRCPCH FOP

A 4-year-old boy has painful stooling, faecal soiling and a palpable loaded rectum. He has no delayed passage of meconium, weight loss or abnormal neurology. What is the most appropriate management?

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Correct answer: B — Macrogol disimpaction regimen with behavioural support

Overflow soiling with a loaded rectum indicates faecal impaction, and oral macrogol disimpaction with support is first-line. Lactulose alone is often insufficient for disimpaction. Rectal biopsy is reserved for concern about Hirschsprung disease, which is not suggested here. The pearl is that soiling commonly represents overflow around impacted stool rather than diarrhoea.

Reference: NICE CG99 Constipation in children