TABLE 4

Differential Diagnosis of Constipation

Nonorganic
 Developmental
  Cognitive handicaps
  Attention deficit disorders
 Situational
  Coercive toilet training
  Toilet phobia
  School bathroom avoidance
  Excessive parental interventions
  Sexual abuse
  Other
 Depression
 Constitutional
  Colonic inertia
  Genetic predisposition
 Reduced stool volume and dryness
  Low fiber in diet
  Dehydration
  Underfeeding or malnutrition
Organic
 Anatomic malformations
  Imperforate anus
  Anal stenosis
  Anterior displaced anus
  Pelvic mass (sacral teratoma)
 Metabolic and gastrointestinal
  Hypothyroidism
  Hypercalcemia
  Hypokalemia
  Cystic fibrosis
  Diabetes mellitus
  Multiple endocrine neoplasia type 2B
  Gluten enteropathy
 Neuropathic conditions
  Spinal cord abnormalities
  Spinal cord trauma
  Neurofibromatosis
  Static encephalopathy
  Tethered cord
 Intestinal nerve or muscle disorders
  Hirschsprung disease
  Intestinal neuronal dysplasia
  Visceral myopathies
  Visceral neuropathies
 Abnormal abdominal musculature
  Prune belly
  Gastroschisis
  Down syndrome
 Connective tissue disorders
  Scleroderma
  Systemic lupus erythematosus
  Ehlers-Danlos syndrome
 Drugs
  Opiates
  Phenobarbital
  Sucralfate
  Antacids
  Antihypertensives
  Anticholinergics
  Antidepressants
  Sympathomimetics
 Other
  Heavy-metal ingestion (lead)
  Vitamin D intoxification
  Botulism
  Cow’s milk protein intolerance
  • Reprinted, with permission from Constipation Guidelines Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43(3):e6.