Management of childhood functional constipation in primary care

Functional constipation (FC) is a common condition in children. Physiotherapy added to standard care for childhood FC shows positive results in the hospital. Evidence for the (cost)effectiveness of physiotherapy in primary care is lacking. This dissertation describes the (cost)effectiveness of physiotherapy for childhood FC in primary care, the impact of FC on the quality of life (QoL) of the child, and the prevalence of bladder problems in children with FC.The majority of children in primary care are still having functional constipation related symptoms 8 months after they consulted the general practitioner, or they are using laxatives. Physiotherapy added to standard care by the general practitioner is not significantly better than standard care alone. In children with chronic FC physiotherapy may be (cost)effective compared to standard care alone, but this needs further investigation. Therefore, we recommend GPs to pay more attention to the possible chronicity of FC in children. Active monitoring of FC-related symptoms is necessary to ensure persistent or relapsing symptoms are identified and treated on time.Furthermore, this dissertation shows that the assessment of the QoL of a child with FC can differ significantly between the child-itself and the parents. Moreover, children with FC have more often bladder problems compared to children without FC. Therefore, we recommend clinicians to ask both the child and the parent(s) to get an impression of the impact of the FC on the child’s QoL, and to be alert for bladder problems in children with FC