Perception and Practice in a Diagnosis and Management of Constipation among Pediatricians

Background: The management of functional constipation can be difficult, given its unknown etiology and potential misconceptions on nonpharmacologic treatment and laxatives, not only in caregivers but also among doctors. Several clinical guidelines have been launched to help in the diagnostic and treatment process, but previous studies in various countries have shown that physicians’ perception and practice can differ from the proposed guidelines.

Objective: To determine the perception and practice of constipation among pediatricians

Methods: We performed a national survey among pediatricians using an online 37-item questionnaire that included demographic data, perception and practice in the diagnostic and treatment processes including the concern on laxatives, follow up and referrals of cases with constipation. We used a 5-point scale to determine perception in each aspect.

Results: We received 275 responses from pediatricians, most were female (69%) and subspecialists (56%). The proportions of pediatricians who graduated residency < 5, 5-10, and > 10 years were 34, 25, and 41%, respectively. The primary source of knowledge was noted during residency training (55%). History taking and advice on nonpharmacologic modalities remained important. Only 51.8% considered disimpaction if physical examination or abdominal radiography is suggestive of fecal impaction. Most used lactulose for both disimpaction and maintenance phases (84 and 92%, respectively); however, pediatricians strongly agreed/agreed that the caregivers of constipated children concern about tolerance/dependence for the four commonly used laxatives (lactulose, milk of magnesia, polyethylene glycol, rectal sodium chloride enema) ranged from 46 to 65%.We also found that recently graduated pediatricians were more likely to perform digital rectal examination and provide advice on toilet training and laxative use than the older individuals.

Conclusion: Providing appropriate knowledge on pharmacologic management especially disimpaction and laxatives may likely be helpful for both pediatricians and caregivers of children. The education may also need to be tailored on various pediatricians’ experiences.