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Primary Care Liaison


  • Initial work-up

    • History of onset, frequency of stools, and stool consistency.
    • Associated history of soiling, wetting.
    • Developmental history, toilet training history.
    • Associated behaviour patterns (toilet refusal or withholding behaviours).
    • Dietary history (rarely the main cause).
    • Physical exam including spine, abdomen and perineal, perianal area.
    • Rectal examination is NOT routinely recommended.
    • Abdominal x-ray rarely changes management and is NOT recommended.

    Recommended pre-referral treatment

    • Regular toileting (toilet sits up to 5 minutes, 3 times a day – preferably after meals)
    • Behaviour modification diary (record frequency of bowel actions, star charts, rewards).
    • Laxative therapy.
    • Reassure parents that long term use of laxatives are safe and don't produce a "lazy bowel".
    • Encourage a healthy diet and adequate clear fluids.
    • Treatment and monitoring often required for months.

    When to refer

    • Constipation is prolonged (>6 months) and treatment resistant.
    • Constipation is associated with soiling / wetting.
    • Concern regarding underlying organic cause (Hirschsprung disease or anorectal malformation).

    Referral information needed

    Please collect and include in your referral as much detail as possible. This will assist triage.

    • Previous management – laxative(s) trialed, treatment duration, and outcome.
    • Associated symptoms of soiling or wetting (day, night, or both).
    • Underlying condition that may explain their constipation. (Please specify)


    Parent information:

    References and more reading

    • Paediatric Handbook (2015). Ninth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

    Guideline developed by RCH. First published July 2018. Please read Copyright and Disclaimer