Increased Incidence of Functional Constipation in Children with a History of Perianal Abscess—A Single-Center Retrospective Cohort Study

Abstract

Introduction Functional constipation (FC) is a common gastrointestinal disorder affecting up to 30 % of children. Voluntary stool withholding (e.g., after painful defecation) with consecutive harder and larger stools can result in avoidance patterns. Perianal abscesses (PA) are associated with anal pain and painful stooling. We hypothesized that patients with PA have a higher incidence of subsequent FC compared with children without PA.

Materials and Methods Between January 2010 and December 2016, we retrospectively analyzed all infants (< 365 days of life) presenting at our institution with PA or unilateral inguinal hernia repair (IH; control group). We screened the clinical charts of these patients for outpatient or inpatient visits due to FC according to ROME IV criteria between 01/2010 and 10/2019. Statistical analysis was done using chi-squared test.

Results We included a total of 37 infants with PA and 118 with IH repair (controls). Mean age at presentation for PA was 3.7 ± 0.5 months compared with 4.2 ± 0.3 months at surgery for IH. In the PA group, 6/37 (16%) developed FC compared with 1/118 (1%) in the control group (p-value < 0.01). Patients with PA presented with FC at a mean age of 22.3 ± 4.6 months. Twenty-three of thirty-seven (62%) of PA patients underwent surgery. The development of FC in the PA group was independent of conservative versus surgical treatment (14 vs. 17%, p >0.05).

Conclusion Our study suggests that PA is associated with an increased risk of FC during the further course. Prophylactic stool softening in patients with PA may be considered to prevent subsequent FC.

Keywords

perianal abscess - functional constipation - children

Publikationsverlauf

Eingereicht: 11. Mai 2020

Angenommen: 16. August 2020

Artikel online veröffentlicht:
19. September 2020

• References

• 1 Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 2016; 150 (06) 1443-1455
• 2 Hyams JS, Di Lorenzo C, Saps M. et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2016; 150 (06) 1456-1468
• 3 Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol 2011; 25 (01) 3-18
• 4 Malowitz S, Green M, Karpinski A, Rosenberg A, Hyman PE. Age of onset of functional constipation. J Pediatr Gastroenterol Nutr 2016; 62 (04) 600-602
• 5 Levy EI, Lemmens R, Vandenplas Y, Devreker T. Functional constipation in children: challenges and solutions. Pediatric Health Med Ther 2017; 8: 19-27
• 6 Loening-Baucke V. Functional fecal retention with encopresis in childhood. J Pediatr Gastroenterol Nutr 2004; 38 (01) 79-84
• 7 Tabbers MM, DiLorenzo C, Berger MY. et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58 (02) 258-274
• 8 Koppen IJN, Di Lorenzo C, Saps M. et al. Childhood constipation: Finally something is moving!. Expert Rev Gastroenterol Hepatol 2016; 10: 141-55
• 9 Liem O, Harman J, Benninga M, Kelleher K, Mousa H, Di Lorenzo C. Health utilization and cost impact of childhood constipation in the United States. J Pediatr 2009; 154 (02) 258-262
• 10 Christison-Lagay ER, Hall JF, Wales PW. et al. Nonoperative management of perianal abscess in infants is associated with decreased risk for fistula formation. Pediatrics 2007; 120 (03) e548-e552
• 11 Serour F, Somekh E, Gorenstein A. Perianal abscess and fistula-in-ano in infants: a different entity?. Dis Colon Rectum 2005; 48 (02) 359-364
• 12 Ezer SS, Oğuzkurt P, Ince E, Hiçsönmez A. Perianal abscess and fistula-in-ano in children: aetiology, management and outcome. J Paediatr Child Health 2010; 46 (03) 92-95
• 13 Juth Karlsson A, Salö M, Stenström P. Outcomes of various interventions for first-time perianal abscesses in children. BioMed Res Int 2016; 2016: 9712854
• 14 Buddicom E, Jamieson A, Beasley S, King S. Perianal abscess in children: aiming for optimal management. ANZ J Surg 2012; 82 (1-2): 60-62
• 15 Samuk I, Avinadav E, Barak U. et al. Perianal abscess in infants: Amenable to conservative treatment in selected cases. Pediatr Int 2019; 61 (11) 1146-1150
• 16 Gong Z, Han M, Wu Y, Huang X, Xu WJ, Lv Z. Treatment of first-time perianal abscess in childhood, balance recurrence and fistula formation rate with medical intervention. Eur J Pediatr Surg 2018; 28 (04) 373-377
• 17 Salvatore S, Baldassarre ME, Di Mauro A. et al. Neonatal antibiotics and prematurity are associated with an increased risk of functional gastrointestinal disorders in the first year of life. J Pediatr 2019; 212: 44-51
• 18 Peña A, Bischoff A. Miscellaneous Conditions. In: Surgical Treatment of Colorectal Problems in Children. Cham: Springer; 2015: 487-497