Advances in the Treatment of Refractory Pediatric Constipation
DOI:
https://doi.org/10.52787/agl.v56i1.576Keywords:
Refractory functional constipation, pediatrics, fecal incontinence, laxatives, transanal irrigation, sacral and posterior tibial nerve stimulation, botulinum toxinAbstract
Refractory functional constipation is a persistent challenge in pediatrics. Beyond polyethylene glycol and traditional laxatives, new pharmacological and non-pharmacological therapies are emerging. Among the innovative medications, prosecretory agents like linaclotide (already approved for children over 6 years old), lubiprostone and plecanatide, which increase intestinal secretion, stand out. Other drugs, such as prucalopride (5HT-4 agonist) and pyridostigmine, aim to improve motility. Rectal and interventional therapies include transanal irrigation -which has shown good results-, antegrade enemas and botulinum toxin A injections, which are useful for specific dysfunctions. Biofeedback remains an effective tool. Neuromodulation is emerging as a promising option. Implanted sacral nerve stimulation and non-invasive techniques such as percutaneous/transcutaneous tibial nerve stimulation and transcutaneous sacral neuromodulation demonstrate improvements in symptoms and quality of life. There are therapies that have been little explored but show promise for the future, such as vibrating capsules, magnetic neurostimulation, and mind-body approaches like hypnosis. Specific pediatric research and an individualized treatment approach are crucial to optimize adherence and outcomes in these complex patients.
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