All Bunged Up - A Service Evaluation of a Nurse-Led Constipation Clinic

Background: Constipation is extremely common in children. Up to 30% of children suffer with constipation, lasting longer than 6 months in 5%. This constipation clinic was set up to provide specialist constipation management with the aim of treating and discharging all children within 2 years. However a significant number of patients are difficult to manage and remain in the clinic beyond 2 years.

Objective: The aim of this service evaluation was to analyse the characteristics of these children for common features that would allow early identification of potentially difficult cases. Additionally, their management within the clinic was evaluated to see if any improvements would aid more rapid treatment and earlier discharge.

Methods: A search was conducted for patients who had been in the paediatric outpatient constipation clinic for greater than 2 years. Their medical notes were reviewed to identify any features of this population and their management in the clinic that could lead to their ongoing difficulties with constipation.

Results: 91 patients were included in the evaluation, ranging in age from 4 to 16. Particularly noticeable common features of these patients included soiling associated with constipation in 91.2%, withholding/avoidance of using the toilet in 46.1% and issues with compliance in 34%. Furthermore they had a significant number of changes to their management (many had over 15 medication changes) in clinic, making compliance more difficult.

Conclusion: Recommendations were made for changes to management including giving the patients constipation management plans to aid patient compliance with medication and SOS appointments for those stable on therapy who may relapse. It is clear that this particular subset of paediatric patients with constipation have ongoing difficulties despite intensive outpatient management and, as they would benefit from more individualised therapy, our ongoing work involves developing a risk assessment tool to identify them early.