Adherence and Outcomes in Functional Constipation With a Constipation Action Plan

Functional Constipation is one of the most common chief complaints for both the general pediatrician and the pediatric gastroenterologist. Treatment for this disorder is multifactorial, and usually involves different medications combined with behavioral techniques, depending on the severity of the underlying constipation. Studies have shown that medication compliance is one of the strongest predictors of successful treatment, but maintaining good medication adherence at home is uncommon for a variety of reasons. In this study, the investigators are aiming to improve home medication adherence for functional constipation to improve treatment outcomes. The investigators will be administering surveys for all enrolled participants to determine the child's and family's overall quality of life related to functional constipation. For the treatment group, the investigators will be providing tools to help with medication adherence. This will include a daily log to determine symptom severity, along with an "action plan" with instructions for how to adjust medicines, if necessary, depending on symptoms. By empowering families with this knowledge and medication roadmap, the investigators hypothesize that there will be overall symptomatic improvement in functional constipation, along with improved quality of life for both the patient and their family. The investigators will measure adherence (by reviewing symptom log and action plan at 2-month and 4-month follow up appointments.) with the treatment group. The investigators will be measuring overall quality of life and symptom improvement using a validated pediatric constipation quality of life survey (PedsQL GI) with both the treatment group and the control group at follow up appointments.

Inclusion criteria

• Have been potty-trained for stool at some point
• Chief complaint constipation or encopresis
• Meets Rome IV criteria for functional constipation

Exclusion criteria

• Preexisting diagnoses of autism, cerebral palsy, developmental delay, and/or thyroid disease
• Prior gastrointestinal surgery
• Presence of "red flag" symptoms for organic etiology:
• Passage of meconium >48 hours after birth in a term newborn
• Family history of Hirschsprung's Disease
• "Ribbon" stools
• Blood in stools (in absence of anal fissure)
• Coexisting diagnosis of malnutrition, bilious vomiting, abnormal anal positioning, absent anal reflex, decreased lower extremity strength/tone, sacral dimple, and/or tuft of hair on spine