Evidence for Nondrug Childhood Constipation Therapies Limited

Although there is a lack of high-quality evidence for nonpharmacologic treatments for childhood constipation, there is some evidence of effectiveness of fiber supplements, but not for effectiveness of fluid supplements, prebiotics, probiotics, or behavioral interventions, according to a review published online Sept. 26 in Pediatrics.

MONDAY, Sept. 26 (HealthDay News) -- Although there is a lack of high-quality evidence for nonpharmacologic treatments for childhood constipation, there is some evidence of effectiveness of fiber supplements, but not for effectiveness of fluid supplements, prebiotics, probiotics, or behavioral interventions, according to a review published online Sept. 26 in Pediatrics.

Merit M. Tabbers, M.D., Ph.D., from the Emma Children's Hospital/Academic Medical Center in Amsterdam, Netherlands, and colleagues reviewed available literature to summarize the evidence and assess the reported quality of studies on nonpharmacologic treatments for childhood constipation. Treatments analyzed included fiber, fluid, prebiotics, probiotics, physical movement, behavioral therapy, multidisciplinary treatment, and forms of alternative medicine. Nine systematic reviews and randomized controlled trials (RCTs) with 640 children were included in the analysis. Methodological quality was independently rated by two reviewers. Meta-analysis could not be performed due to considerable heterogeneity across studies.

The investigators found some evidence of fiber being more effective than placebo in reducing abdominal pain, and improving both the frequency and consistency of stools. There was no evidence that water intake or hyperosmolar fluid treatment increased stool frequency or decreased difficulty in passing stool compared to normal fluid intake. Use of prebiotics or probiotics could not be recommended due to lack of evidence. Behavioral therapy with laxatives had no advantage over use of laxatives alone. No RCTs were identified for physical movement, multidisciplinary treatment, or alternative medicine.

"There is a lack of well-designed RCTs of high quality concerning nonpharmacologic treatments for children with functional constipation," the authors write.

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