💩 Constipation & Encopresis · Pediatric Decision Tool

Schwartz Clinical Handbook — Chapter 22 · Functional constipation · Hirschsprung disease · Encopresis · Disimpaction · Rome IV criteria

Select stool frequency, consistency, pain with defecation, soiling, abdominal distension, and red flags (delayed meconium, ribbon stools, FTT) → differentiate functional constipation from organic causes (Hirschsprung, celiac, hypothyroidism).
⚠️ Red flags: failure to pass meconium >48h, ribbon-like stools, poor weight gain, bilious vomiting → urgent surgical referral.

📋 Step 1 — Bowel pattern & alarm features
📌 Diagnostic impressions
📖 Schwartz Ch 22

Select stool frequency, consistency, toileting behavior, abdominal exam, and red flags → system applies Rome IV criteria for functional constipation and identifies organic causes (Hirschsprung, spinal dysraphism, hypothyroidism, celiac).

✔️ Hard stools, painful defecation, retentive posturing → functional.
✔️ Delayed meconium + ribbon stools + empty rectum + FTT → Hirschsprung.
✔️ Encopresis + soiling + palpable stool → disimpaction needed.
✔️ Infant dyschezia: straining, soft stools → normal, self‑limited.
📘 Schwartz pearls (Chapter 22)
• Functional constipation: disimpaction (PEG 3350) then maintenance.
• Hirschsprung: rectal biopsy (absent ganglion cells).
• Anorectal manometry can help differentiate.
• Always perform rectal exam: sphincter tone, stool in ampulla (present in functional, absent in Hirschsprung).