Management of functional constipation in children and adults

Nat Rev Gastroenterol Hepatol. 2020 Jan;17(1):21-39. doi: 10.1038/s41575-019-0222-y. Epub 2019 Nov 5.


Functional constipation is common in children and adults worldwide. Functional constipation shows similarities in children and adults, but important differences also exist regarding epidemiology, symptomatology, pathophysiology, diagnostic workup and therapeutic management. In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives. In adults, management focuses on excluding an underlying cause and differentiating between different subtypes of functional constipation - normal transit, slow transit or an evacuation disorder - which has important therapeutic consequences. Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions (in the presence of a rectal evacuation disorder) and pharmacological therapy. When conventional treatments fail, children and adults are considered to have intractable functional constipation, a troublesome and distressing condition. Intractable constipation is managed with a stepwise approach and in rare cases requires surgical interventions such as antegrade continence enemas in children or colectomy procedures for adults. New drugs, including prokinetic and prosecretory agents, and surgical strategies, such as sacral nerve stimulation, have the potential to improve the management of children and adults with intractable functional constipation.

Publication types

  • Review

MeSH terms

  • Adult
  • Bile Acids and Salts / therapeutic use
  • Biofeedback, Psychology
  • Child
  • Chloride Channel Agonists / therapeutic use
  • Cholinesterase Inhibitors / therapeutic use
  • Constipation / diagnosis
  • Constipation / physiopathology
  • Constipation / therapy*
  • Diet Therapy
  • Dietary Fiber
  • Disease Management
  • Electric Stimulation Therapy
  • Enema
  • Gastrointestinal Agents / therapeutic use*
  • Gastrointestinal Microbiome
  • Gastrointestinal Transit
  • Guanylyl Cyclase C Agonists / therapeutic use
  • Humans
  • Laxatives / therapeutic use*
  • Manometry
  • Patient Education as Topic
  • Prebiotics
  • Probiotics
  • Serotonin 5-HT4 Receptor Agonists / therapeutic use*
  • Toilet Training


  • Bile Acids and Salts
  • Chloride Channel Agonists
  • Cholinesterase Inhibitors
  • Dietary Fiber
  • Gastrointestinal Agents
  • Guanylyl Cyclase C Agonists
  • Laxatives
  • Prebiotics
  • Serotonin 5-HT4 Receptor Agonists