Physiologic causes of constipation |
Functional constipation* (may have dietary or behavioral triggers, exacerbated by painful defecation and stool withholding) |
Cow's milk or other dietary protein intolerance* |
Low dietary fiber* |
Slow-transit constipation |
Inadequate fluid intake (during fever or hot weather) |
Immobility |
Anorexia nervosa |
Starvation |
Neurogenic causes |
Hirschsprung disease¶Δ |
Cerebral palsy |
Myelomeningocele |
Spinal cord injury |
Closed spinal dysraphism¶◊ (eg, tethered cord, sacral agenesis, split spinal cord malformation [diastematomyelia]) |
Sacral teratoma¶Δ |
Neurofibromatosis |
Muscular weakness (may be generalized, as in Down syndrome, or due to abnormal abdominal musculature,Δ as in prune belly syndrome or gastroschisis) |
Infantile botulism¶Δ (constipation is an early complaint; other features are facial and ocular palsies, poor suck and hypotonia) |
Pseudo-obstruction (eg, visceral neuropathies, myopathies, mitochondrial disorders) |
Intestinal neuronal dysplasia |
Familial or acquired dysautonomia |
Duchenne muscular dystrophy |
Endocrine and metabolic causes |
Cystic fibrosis¶ (with meconium ileus in neonatesΔ or distal intestinal obstruction syndrome in older children) |
Hypokalemia |
Lead poisoning¶ |
Vitamin D intoxication |
Hypo- or hypercalcemia |
Hypothyroidism |
Diabetes mellitus |
Pheochromocytoma |
Multiple endocrine neoplasia type 2B (MEN2B) |
Polyuria (leading to dehydration) |
Juvenile systemic sclerosis (scleroderma) or mixed connective tissue disease |
Acute intermittent porphyria |
Anatomic causes |
Anorectal anomalies (imperforate anus,Δ anteriorly displaced anus) |
Intestinal obstruction¶ (in neonates, consider atresia, webs, or volvulus)Δ |
Small left colon syndromeħ |
Other causes |
Celiac disease* |
Medications (opiates, anticholinergics, antidepressants, chemotherapy, aluminum-containing antacids) |
Generalized joint hypermobility |
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