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EVIDENCE REPOSITORY

Constipation

Developed by:ARCHE, & TREKK

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Last Updated
Aug 2026

Topic
Functional Constipation

EVIDENCE REPOSITORIES

This evidence repository is a collection of best available resources and evidence collated by a knowledge synthesis team at Alberta Research for Health Evidence (ARCHE) and the clinical content team.

The knowledge synthesis team utilizes a pyramid-shaped framework, built upon the “4S” hierarchy of evidence model, to provide  detailed evidence appropriate to meet stakeholders’ needs. They search a combination of databases (Cochrane Library, PubMed,  TRIP Database) and web-based search engines (Google, Google Scholar) to locate evidence for the knowledge pyramids.  Publication types sought in the initial topic searches are organized into five levels that determine the order in which resources are presented:

  1. Clinical Practice Guidelines and Pathways
  2. Overviews and Summaries of Systematic Reviews
  3. Systematic Reviews
  4. Key Studies

Where applicable resources for families and parents are also listed.

The knowledge synthesis team collaborates with the clinical content team to select the most relevant guidelines, reviews, and key  studies, which can be found below. This evidence repository is not intended to be an exhaustive list of resources for a topic, but  rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general  emergency department setting. Every effort is made to identify resources that are open access (i.e. publicly available, free of  charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found here.

Content Team

Thank you to the following content experts and Knowledge Synthesis team who led the development of this evidence repository.

Mohamed Eltorki, MD Assistant Clinical Professor, Division of Emergency Medicine McMaster University

Paige Landy, MD Western University, Paediatric Emergency Medicine Fellow

Samantha Guitard, MSc Evidence Synthesis Scientist, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

Sarah Elliott, PhD Assistant Director, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

References in bold correspond to those used in the Bottom Line Recommendation.

Clinical Practice Guidelines and Pathways

  1. Allen P, Setya A, Lawrence VN. Pediatric Functional Constipation. StatPearls [Internet]. 2025.
  2. Kids Health Western Australia. Constipation. Government of Western Australia Child and Adolescent Health Service. 2022.
  3. Alberta Health Services. Pediatric Constipation Primary Care Pathway. Updated 2022.
  4. National Institute for Health and Care Excellence. Constipation in children and young people: Diagnosis and management.  National Institute for Health and Care Excellence. 2017.
  5. Paul SP, Broad SR, Spray C. Idiopathic constipation in children clinical practice guidelines. Arch Dis Child Educ Pract Ed. 2016;101(2):65-9.
  6. Hyams JS, Di Lorezo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Childhood Functional Gastrointestinal Disorders:  Child/Adolescent. Gastroenterology. 2016;150(6):1456-68.e2.
  7. Drossman DA. Functional gastrointestinal disorders: History, pathophysiology, clinical features and Rome IV.  Gastroenterology. 2016:S0016-5085(16)00223-7.
  8. Benninga MA, Faure C, Hyman PE, et al. Childhood functional gastrointestinal disorders: Neonate/toddler.  Gastroenterology. 2016:S0016-5085(16)00182-7.
  9. Colombo JM, Wassom MC, Rosen JM. Constipation and encopresis in childhood. Pediatr Rev. 2015;36(9):392-401; quiz 2.
  10. Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children:  Evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258-74. 

Overviews and Summaries of Systematic Reviews

  1. Wang Q, Ren T, Wang H, Lin X. The effect of probiotics on the diarrhea and constipation outcomes in children: an umbrella  review of systematic reviews and meta-analyses. Front Nutr. 2025;12:1606264.
  2. Southwell BR. Treatment of childhood constipation: A synthesis of systematic reviews and meta-analyses. Expert Rev Gastroenterol Hepatol. 2020;14(3):163-74.

Systematic Reviews

  1. Arruda Navarro Albuquerque D, de Geus A, Gordon M, et al. Efficacy and safety of non-pharmacological treatments for paediatric functional constipation: a systematic review and meta-analysis. BMJ Paediatr Open. 2026;10(1).
  2. Chen L, Wang Y, Liu X, Wong H, Huang C. Probiotics for pediatric diarrhea and constipation: an umbrella meta-analysis.  BMC Pediatr. 2025;25(1):698.
  3. de Geus A, Gordon M, Sinopoulou V, et al. Efficacy and safety of pharmacological therapies for functional constipation in  children: a systematic review and meta-analysis. Lancet Child Adolesc Health. 2025;9(12):848–56.
  4. Gordon M, Lakunina S, de Geus A, et al. Systematic literature review and meta-analysis on therapeutic management of  faecal impaction in the paediatric population. BMJ Paediatr Open. 2025;9(1):E003483.
  5. Hao J, Remis A, Tang Y, et al. Pelvic floor physical therapy for functional constipation in children: a systematic review and  meta-analysis. Pediatr Surg Int. 2025;41(1):125.
  6. Jonker CAL, van der Zande JMJ, Benninga MA, et al. Antegrade Continence Enemas for Pediatric Functional Constipation:  A Systematic Review. J Pediatr Surg. 2025;60(1):161952.
  7. Gordon M, Grafton-Clarke C, Rajindrajith S, Benninga MA, Sinopoulou V, Akobeng AK. Treatments for intractable  constipation in childhood. Cochrane Database Syst Rev. 2024;6(6):CD014580.
  8. Burton LM, Skelton J, Harry O, Zuar L. Systematic review of family and pediatric constipation: An overlooked piece of the  puzzle. J Pediatr Gastroenterol Nutr. 2024;79(2):309–14.
  9. Kim E, Chang S, Nam J, Park N, Min SY. The synergistic effect of herbal medicine and probiotics in pediatric functional  constipation: A systematic review and meta-analysis. Medicine (Baltimore). 2024;103(7):e36899.
  10. Vos J, Bloem MN, de Geus A, et al. Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal  impaction in children: a systematic review and meta-analysis. Pediatr Radiol. 2024;54(13):2227–42.
  11. Liu L, Wang A, Shi H, Tao H, Nahata MC. Efficacy and safety of probiotics and synbiotics for functional constipation in  children: A systematic review and meta-analysis of randomized clinical trials. Clin Nutr. 2023;42(10):1817–26.
  12. Katsagoni CN, Karagianni VM, Papadopoulou A. Efficacy of Different Dietary Patterns in the Treatment of Functional  Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies. Nutrients. 2023;15(12):2708.
  13. Rachel H, Griffith AF, Teague WJ, et al. Polyethylene glycol dosing for constipation in children younger than 24 months: A  systematic review. J Pediatr Gastroenterol Nutr. 2020;71(2):171-5.
  14. Harris RG, Neale EP, Ferreira I. When poorly conducted systematic reviews and meta-analyses can mislead: A critical  appraisal and update of systematic reviews and meta-analyses examining the effects of probiotics in the treatment of functional constipation in children. Am J Clin Nutr. 2019;110(1):177-95.
  15. Wegh CAM, Benninga MA, Tabbers MM. Effectiveness of probiotics in children with functional abdominal pain disorders  and functional constipation: A systematic review. J Clin Gastroenterol. 2018;52 Suppl 1, Proceedings from the 9th Probiotics, Prebiotics and New Foods, Nutraceuticals and Botanicals for Nutrition & Human and Microbiota Health  Meeting, Rome, Italy. Sept 10, 2017:S10-s26.
  16. Piccoli de Mello P, Eifer DA, Daniel de Mello E. Use of fibers in childhood constipation treatment: Systematic review with meta-analysis. J Pediatr. 2018;94(5):460-70.
  17. Axelrod CH, Saps M. The role of fiber in the treatment of functional gastrointestinal disorders in children. Nutrients.  2018;10(11).
  18. Koppen IJ, Benninga MA, Tabbers MM. Is there a role for pre-, pro- and synbiotics in the treatment of functional  constipation in children? A systematic review. J Pediatr Gastroenterol Nutr. 2016;63 Suppl 1:S27-35.
  19. Gordon M, MacDonald JK, Parker CE, et al. Osmotic and stimulant laxatives for the management of childhood  constipation. Cochrane Database Syst Rev. 2016(8):CD009118.
  20. Koppen IJ, Lammers LA, Benninga MA, Tabbers MM. Management of functional constipation in children: Therapy in  practice. Paediatr Drugs. 2015;17(5):349-60.
  21. Sandhu BK, Paul SP. Irritable bowel syndrome in children: Pathogenesis, diagnosis and evidence-based treatment. World J  Gastroenterol. 2014;20(20):6013-23.
  22. Berger MY, Tabbers MM, Kurver MJ, et al. Value of abdominal radiography, colonic transit time, and rectal ultrasound  scanning in the diagnosis of idiopathic constipation in children: A systematic review. J Pediatr. 2012;161(1):44-50.e1-2.
  23. Tabbers MM, Boluyt N, Berger MY, Benninga MA. Nonpharmacologic treatments for childhood constipation: Systematic  review. Pediatrics. 2011;128(4):753-61.
  24. Brazzelli M, Griffiths PV, Cody JD, Tappin D. Behavioural and cognitive interventions with or without other treatments for  the management of faecal incontinence in children. Cochrane Database Syst Rev. 2011(12): CD002240.
  25. Tabbers MM, Boluyt N, Berger MY, Benninga MA. Constipation in children. BMJ Clin Evid. 2010;2010:0303.
  26. Pijpers MA, Tabbers MM, Benninga MA, Berger MY. Currently recommended treatments of childhood constipation are not  evidence based: A systematic literature review on the effect of laxative treatment and dietary measures. Arch Dis Child.  2009;94(2):117-31.
  27. Reuchlin-Vroklage LM, Bierma-Zeinstra S, Benninga MA, Berger MY. Diagnostic value of abdominal radiography in  constipated children: A systematic review. Arch Pediatr Adolesc Med. 2005;159(7):671-8.

Key Studies

  1. Tran DL, Sintusek P. Efficacy and palatability of the developed polyethylene glycol-based formula for the treatment of children with functional constipation. World J Clin Pediatr. 2025;14(4):108854.
  2. Keihanian F, Maleknejad S, Saeidinia A, Soltanipour S, Pirooz A. Comparison of Ziziphus jujube Mill. Syrup versus  polyethylene glycol in children with functional constipation: a randomized clinical trial. Sci Rep. 2025;15(1):1674.
  3. Malekiantaghi A, Miladi M, Shabani Mirzaee H, Tolou Ostadan Yazd M, Eftekhari K. Abdominal massage as an adjunctive  therapy for pediatric functional constipation: a randomized controlled trial. Turk J Pediatr. 2025;67(5):669–77.
  4. Bai X, Li D, Tian Y, et al. Effects of Chinese pediatric therapeutic massage on the management of functional constipation in  children: A randomized single blind trial. Medicine (Baltimore). 2025;104(52):e46865.
  5. Vadlapudi SS, Poddar U, Srivastava A, Sarma MS. Efficacy of Home-Based Versus Hospital-Based Disimpaction with  Polyethylene Glycol in Pediatric Functional Constipation: A Randomized Control Study. Dig Dis Sci. 2025;70(8):2750–9.
  6. Di Lorenzo C, Nurko S, Hyams JS, et al. Randomized controlled trial of linaclotide in children aged 6-17 years with  functional constipation. J Pediatr Gastroenterol Nutr. 2024;78(5):1059–68.
  7. Di Lorenzo C, Robert J, Rodriguez-Araujo G, Shakhnovich V, Xie W, Nurko S, et al. Safety and efficacy of linaclotide in  children aged 2-5 years with functional constipation: Phase 2, randomized study. J Pediatr Gastroenterol Nutr. 2024;79(3):510–8.
  8. Elkaragy ES, Shamseya MM, Metwally RH, Mansour ER, Lashen SA. Efficacy of lubiprostone for functional constipation  treatment in adolescents and children: Randomized controlled trial. J Pediatr Gastroenterol Nutr. 2024;78(4):800–9.
  9. Ansari Chaharsoghi N, Davoodi M, Reihani H, et al. A Comparison of the Effect of Kegel Exercises and Conventional  Therapy versus Conventional Therapy Alone in the Treatment of Functional Constipation in Children: A Randomized  Clinical Trial. Iran J Med Sci. 2024;49(5):286–93.
  10. Gu X, Yang Z, Kou Y, et al. Effects of Retrograde Colonic Enema-Based Fecal Microbiota Transplantation in the Treatment  of Childhood Constipation: A Randomized, Double-Blind, Controlled Trial. Am J Gastroenterol. 2024;119(11):2288–97.
  11. Heemskerk SCM, Dirksen CD, van Kuijk SMJ, et al. Sacral Neuromodulation Versus Conservative Treatment for Refractory  Idiopathic Slow-transit Constipation: The Randomized Clinical No.2-Trial. Ann Surg. 2024;279(5):746–54.
  12. Yu ZT, Song JM, Qiao L, et al. A Randomized, Double-Blind, Controlled Trial of Percutaneous Tibial Nerve Stimulation  With Pelvic Floor Exercises in the Treatment of Childhood Constipation. Am J Gastroenterol. 2023;118(3):553–60.
  13. Lojanatorn P, Phrommas J, Tanpowpong P, Getsuwan S, Lertudomphonwanit C, Treepongkaruna S. Efficacy of Bacillus  clausii in Pediatric Functional Constipation: A Pilot of a Randomized, Double-Blind, Placebo-Controlled Trial. Indian  Pediatr. 2023;60(6):453–8.
  14. Anwar Ul Haq MM, Lyons H, Halim M. Pediatric abdominal x-rays in the acute care setting – are we overdiagnosing constipation? Cureus. 2020;12(3):e7283.
  15. Jarzebicka D, Sieczkowska-Golub J, Kierkus J, et al. Peg 3350 versus lactulose for treatment of functional constipation in  children: Randomized study. J Pediatr Gastroenterol Nutr. 2019;68(3):318-24.
  16. Dehghani SM, Bahroloolomifard MS, Yousefi G, et al. A randomized controlled double blinded trial to evaluate efficacy of  oral administration of black strap molasses (sugarcane extract) in comparison with polyethylene glycol on pediatric  functional constipation. J Ethnopharmacol. 2019;238:111845.
  17. Benninga MA, MENA Infant Constipation Study Group, Vandenplas Y. The magnesium-rich formula for functional  constipation in infants: A randomized comparator-controlled study. Pediatr Gastroenterol Hepatol Nutr. 2019;22(3):270-81.
  18. Modin L, Walsted AM, Dalby K, Jakobsen MS. Polyethylene glycol maintenance treatment for childhood functional  constipation: A randomized, placebo-controlled trial. J Pediatr Gastroenterol Nutr. 2018;67(6):732-7.
  19. van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, de Bie RA. Effectiveness of pelvic  physiotherapy in children with functional constipation compared with standard medical care. Gastroenterology.  2017;152(1):82-91.
  20. Freedman SB, Rodean J, Hall M, et al. Delayed diagnoses in children with constipation: Multicenter retrospective cohort  study. J Pediatr. 2017;186:87-94.e16.
  21. Shaikh N, Hoberman A, Keren R, et al. Recurrent urinary tract infections in children with bladder and bowel dysfunction.  Pediatrics. 2016;137(1):e20152982.
  22. Ormarsson OT, Asgrimsdottir GM, Loftsson T, Stefansson E, Lung SH, Bjornsson ES. Free fatty acid suppositories are as  effective as docusate sodium and sorbitol enemas in treating constipation in children. Acta Paediatr. 2016;105(6):689-94.
  23. Modin L, Walsted AM, Rittig CS, Hansen AV, Jakobsen MS. Follow-up in childhood functional constipation: A randomized, controlled clinical trial. J Pediatr Gastroenterol Nutr. 2016;62(4):594-9.
  24. Vilke GM, DeMers G, Patel N, Castillo EM. Safety and efficacy of milk and molasses enemas in the emergency department. J Emerg Med. 2015;48(6):667-70.
  25. Jordan-Ely J, Hutson JM, Southwell BR. Disimpaction of children with severe constipation in 3-4 days in a suburban clinic using polyethylene glycol with electrolytes and sodium picosulphate. J Paediatr Child Health. 2015;51(12):1195-8.
  26. Boles EE, Gaines CL, Tillman EM. Comparison of polyethylene glycol-electrolyte solution vs polyethylene glycol-3350 for  the treatment of fecal impaction in pediatric patients. J Pediatr Pharmacol Ther. 2015;20(3):210-6.
  27. Freedman SB, Thull-Freedman J, Rumantir M, Eltorki M, Schuh S. Pediatric constipation in the emergency department: Evaluation, treatment, and outcomes. J Pediatr Gastroenterol Nutr. 2014;59(3):327-33.
  28. Freedman SB, Thull-Freedman J, Manson D, et al. Pediatric abdominal radiograph use, constipation, and significant misdiagnoses. J Pediatr. 2014;164(1):83-8.e2.
  29. Hansen SE, Whitehill JL, Goto CS, Quintero CA, Darling BE, Davis J. Safety and efficacy of milk and molasses enemas  compared with sodium phosphate enemas for the treatment of constipation in a pediatric emergency department. Pediatr  Emerg Care. 2011;27(12):1118-20.
  30. Bekkali NL, van den Berg MM, Dijkgraaf MG, et al. Rectal fecal impaction treatment in childhood constipation: Enemas versus high doses oral peg. Pediatrics. 2009;124(6):e1108-15.
  31. Patel H, Law A, Gouin S. Predictive factors for short-term symptom persistence in children after emergency department  evaluation for constipation. Arch Pediatr Adolesc Med. 2000;154(12):1204-

Other Resources

  1. Koppen IJ, Lammers LA, Benninga MA, et al. Flowchart of evaluation and management of functional constipation in children. Paediatric Drugs. 2015.
  2. NICE. Bristol Stool Chart. National Institute for Health and Care Excellence. 2013.

Resources for Families

  1. ARCHE-ECHO. Caring for a child with functional constipation. Video, 2020. Available from echokt.ca, accessed March 4th,  2026.
  2. ARCHE-ECHO. Caring for a child with functional constipation. Interactive Infographic, 2020. Available from echokt.ca,  accessed March 4th, 2026.
  3. Boctor D. The role of dietary fibre and prebiotics in the paediatric diet. Canadian Paediatric Society, Nutrition and  Gastroenterology Committee. 2020.
  4. MCH. MCH GoPoop PROGRAM. McMaster Children’s Hospital. 2021.
  5. CHEO. WHAT YOU NEED TO KNOW: CONSTIPATION. Children’s Hospital of Eastern Ontario. 2020.
  6. CHEO. CE QU’IL FAUT SAVOIR : LA CONSTIPATION. Children’s Hospital of Eastern Ontario. 2020.
  7. CHU Sainte-Justine. Constipation fonctionnelle et encoprésie. CHU Sainte-Justine. 2023.
  8. Caring for Kids, Canadian Paediatric Society. Healthy bowel habits for children. 2018.