A Classification of Disorders of Defecation in Infants and Children

Abstract

During the 45 years since the publication of a surgical treatment for Hirschsprung's Disease, much more attention has been given to differentiating aganglionic from functional megacolon than other, less common disorders of defecation that nevertheless present to pediatric gastroenterologists for diagnosis and management. This article presents a diagnostic schema that may be used to categorize and disorder of defication, assist in their differential diagnosis, and foster inquiry into their nature. The schema is predicted on: (1) an understanding of the anatomy and sensorimotor physiology of the apparatus of defecation and fecal continence, (2) an understanding of child development and they way infants and children think about their eliminative functions and products, and (3) the perceptual motor development process by which children acquire toileting skills.