A new study by University of Iowa researchers has shown that the most common cause of abdominal pain among children is acute and chronic constipation.
The study also recommended that doctors should do a simple rectal examination for constipation when trying to find out the cause of abdominal pain in kids. The findings, which were based on medical records of 962 children ages 4 to nearly 18, showed that constipation together accounted for nearly half of all cases of acute abdominal pain in children treated at one hospital.
Vera Loening-Baucke, M.D., professor of pediatrics at the University of Iowa Carver College of Medicine and the study's lead investigator, said previous studies have shown that constipation can contribute to abdominal pain in kids, but no specific recommendations for diagnosing this contributing factor were made.
"Constipation can be overlooked as the cause of severe or intermittent abdominal pain, as a reporting of symptoms alone does not always establish that a child has constipation. Our study helps to show that constipation frequently causes acute abdominal pain and that a physician should not just ask the parent if the child is constipated because the parent may have not been able to see all the signs of this condition," she said.
Constipation signs include fewer than three bowel movements per week, one or more episodes of stool incontinence per week, passing of stools so large that they obstruct the toilet, retentive posturing (withholding behaviour) and painful defecation.
"The doctor should perform an abdominal examination and a rectal examination to see if the child is retaining stool," Loening said. She said that some physicians shy away from conducting rectal examination, which involves digitally checking for impacted stool in the lower colon, because they believe it may cause a child mental or physical discomfort. However, the test can be performed safely and explained to kids so that they understand its purpose.
"It's important for doctors to do a thorough evaluation for abdominal pain, as there are many causes. In addition to constipation, having a cold or sore throat can also cause abdominal pain, for example," Loening said.
During the study, it was found that 83 of 962 kids who had received at least one 'well-child' visit during a six-month period in 2004 at University of Iowa Children's Hospital or University of Iowa Hospitals and Clinics reported acute abdominal pain at that visit or another clinic or emergency visit. Significantly more girls (12 percent of the 962) reported such pain, compared to only 5 percent of boys.
Out of 83 kids with acute abdominal pain, 72 were seen in a primary care clinic and 11 were examined after hours in the emergency department. Together, acute constipation (lasting eight or fewer weeks) and chronic constipation (lasting eight or more weeks) accounted for 48 percent of the cases (40 children), making it the most common cause of the pain.
Only 2 percent of the kids with pain had a surgical condition such as appendicitis. In addition, doctors could not determine causes for 19 percent of the patients with pain. The findings are published in the December issue of the Journal of Pediatrics.