Editing Functional constipation (section)

== Treatment ==
Treatment for functional constipation begins with nonpharmacological management. This includes education and lifestyle modifications, such as diet changes, consistent exercise, and guidance on proper body position and behavior when using the restroom.<ref name="Management">{{cite journal | last1=Vriesman | first1=Mana H. | last2=Koppen | first2=Ilan J. N. | last3=Camilleri | first3=Michael | last4=Di Lorenzo | first4=Carlo | last5=Benninga | first5=Marc A. | title=Management of functional constipation in children and adults | journal=Nature Reviews Gastroenterology & Hepatology | publisher=Springer Science and Business Media LLC | volume=17 | issue=1 | date=2019-11-05 | issn=1759-5045 | doi=10.1038/s41575-019-0222-y | pages=21–39| pmid=31690829 }}</ref>

The first treatments for constipation are dietary guidelines, which include the requirement for a regular consumption of [[fiber]] and fluids. A normal intake of fiber is advocated for children with functional constipation, as per the criteria of ESPGHAN/NASPGHAN. It is not recommended to increase the consumption of fiber above what is considered normal.<ref name="ESPGHAN and NASPGHAN">{{cite journal | last1=Tabbers | first1=M.M. | last2=DiLorenzo | first2=C. | last3=Berger | first3=M.Y. | last4=Faure | first4=C. | last5=Langendam | first5=M.W. | last6=Nurko | first6=S. | last7=Staiano | first7=A. | last8=Vandenplas | first8=Y. | last9=Benninga | first9=M.A. | title=Evaluation and Treatment of Functional Constipation in Infants and Children | journal=Journal of Pediatric Gastroenterology and Nutrition | publisher=Wiley | volume=58 | issue=2 | year=2014 | issn=0277-2116 | doi=10.1097/mpg.0000000000000266 | pages=258–274| pmid=24345831 }}</ref>

In order to effectively treat childhood constipation, it is imperative that parents and children receive counseling. This includes teaching them about the concept of [[overflow incontinence]] and the significance of withholding behavior.<ref name="Management"/> One way to reduce [[Fecal impaction|faecal impaction]] and lower the risk of [[Fecal incontinence|faecal incontinence]] is to use an organized [[Toilet training|toilet-training]] program with a reward system that instructs the kid to try to defaecate at least twice or three times a day (after each meal).<ref name="c555">{{cite journal | last1=van der Plas | first1=R. N. | last2=Benninga | first2=M. A. | last3=Taminiau | first3=J. A. J. M. | last4=Büller | first4=H. A. | title=Treatment of defaecation problems in children: the role of education, demystification and toilet training | journal=European Journal of Pediatrics | publisher=Springer Science and Business Media LLC | volume=156 | issue=9 | date=1997-08-20 | issn=0340-6199 | doi=10.1007/s004310050691 | pages=689–692| pmid=9296531 }}</ref>

Children with functional constipation can be treated pharmacologically in two stages: maintenance therapy and faecal disimpaction. High-dose oral [[Polyethylene glycol|polyethylene glycol (PEG)]] or [[Enema|enemas]] containing active substances such [[sodium phosphate]], [[sodium lauryl sulfoacetate]], or [[docusate|sodium docusate]] can be used to induce fecal disimpaction.  Maintenance therapy is suggested following successful disimpaction in order to avoid reoccurring stool buildup. Adults rarely need faecal disimpaction, although the methods are comparable, and substantial doses of PEG or [[magnesium citrate]] are popular oral therapies. For both adults and children, [[glycerine]] or [[bisacodyl]] suppositories provide an alternative to [[Enema|enemas]].<ref name="Management"/>

The first-choice maintenance treatment advised for functional constipation is [[Osmotic laxative|osmotic laxatives]].<ref name="ESPGHAN and NASPGHAN"/><ref name="w055">{{cite journal | last1=Bharucha | first1=Adil E. | last2=Pemberton | first2=John H. | last3=Locke | first3=G. Richard | title=American Gastroenterological Association Technical Review on Constipation | journal=Gastroenterology | publisher=Elsevier BV | volume=144 | issue=1 | year=2013 | issn=0016-5085 | doi=10.1053/j.gastro.2012.10.028 | pages=218–238| pmid=23261065 | pmc=3531555 }}</ref> Other often used laxatives include [[milk of magnesia]] ([[magnesium hydroxide]]) and [[mineral oil]], a lubricant.<ref name="Management"/> Clinical recommendations advocate using stimulant laxatives, such as [[Senna glycoside|senna]] or [[bisacodyl]], in both adults and children if symptoms are still present.<ref name="ESPGHAN and NASPGHAN"/><ref name="w055"/>

A number of novel therapeutic treatments have been suggested and licensed in recent years for the treatment of functional constipation.<ref name="Management"/> Prosecretory drugs including [[plecanatide]], [[linaclotide]], and [[lubiprostone]] alter gut epithelial channels, encouraging intestinal fluid secretion and increasing stool volume, which improves GI transit.<ref name="z753">{{cite journal | last1=Simrén | first1=Magnus | last2=Tack | first2=Jan | title=New treatments and therapeutic targets for IBS and other functional bowel disorders | journal=Nature Reviews Gastroenterology & Hepatology | publisher=Springer Science and Business Media LLC | volume=15 | issue=10 | date=2018-06-21 | issn=1759-5045 | doi=10.1038/s41575-018-0034-5 | pages=589–605| pmid=29930260 }}</ref> Functional constipation has been treated with a variety of 5-hydroxytryptamine 4 (5-HT4) agonists.<ref name="Management"/> [[Serotonin]] (5-HT) is an enteric and central [[neurotransmitter]] that binds to the gut's [[5-HT4 receptor|5-HT4]] receptors to boost [[acetylcholine]] release, which in turn increases secretion and motility of the gut.<ref name="m429">{{cite journal | last1=Thomas | first1=Rachel H. | last2=Luthin | first2=David R. | title=Current and Emerging Treatments for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation: Focus on Prosecretory Agents | journal=Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy | publisher=Wiley | volume=35 | issue=6 | date=2015-05-27 | issn=0277-0008 | doi=10.1002/phar.1594 | pages=613–630| pmid=26016701 }}</ref> Additionally, serotonin promotes motility by stimulating the mucosa's afferent neurons, which in turn triggers the [[gastrocolic reflex]].<ref name="v463">{{cite journal | last1=Coss-Adame | first1=Enrique | last2=Rao | first2=Satish S. C. | title=Brain and Gut Interactions in Irritable Bowel Syndrome: New Paradigms and New Understandings | journal=Current Gastroenterology Reports | volume=16 | issue=4 | date=2014 | issn=1522-8037 | pmid=24595616 | pmc=4083372 | doi=10.1007/s11894-014-0379-z | page=379}}</ref>