Loening-Baucke V
J Wound Ostomy Continence Nurs. 1994 Mar;21(2):49-58. doi: 10.1097/00152192-199403000-00003.
The evaluation of chronic constipation with or without fecal soiling in children must begin with a careful history and physical examination. Constipation and fecal soiling is caused in fewer than 10% of patients by anatomic, neurologic, endocrine, or metabolic conditions. No specific organic cause can be found in more than 90% of affected children, but anorectal functions--such as rectal sensation, rectal contractility, and relaxation of the external anal sphincter and pelvic floor muscles during straining for defecation--are impaired. Most patients will benefit from a program designed to clear fecal impaction with enemas, prevent fecal impaction with enemas, prevent fecal impaction with laxatives, and promote regular bowel habits with scheduled toilet sittings.
对伴有或不伴有大便失禁的儿童慢性便秘进行评估时，必须首先仔细询问病史并进行体格检查。便秘和大便失禁在不到10%的患者中是由解剖、神经、内分泌或代谢疾病引起的。超过90%的患病儿童找不到特定的器质性病因，但排便时的肛门直肠功能，如直肠感觉、直肠收缩力以及用力排便时肛门外括约肌和盆底肌肉的松弛功能会受损。大多数患者将受益于这样一个方案：用灌肠剂清除粪块嵌塞、用灌肠剂预防粪块嵌塞、用泻药预防粪块嵌塞，并通过定时如厕促进规律排便习惯。
