Benninga et al used specific criteria to identify pediatric patients with constipation. The authors are from Amsterdam, The Netherlands.


Criteria for pediatric constipation - 2 or more of the following:

(1) stool frequency less than 3 times per week (= 0 to 2 times per week)

(2) 2 or more episodes of soiling or encopresis per week

(3) periodic (once every 7 to 30 days) passage of a very large amount of stool

(4) palpable abdominal or rectal mass (in the absence of a tumor)



• The stools are qualified by Felt et al as having a hard consistency and being painful to pass.

• The children studied by Benninga et al ranged in age from 5 to 14 years. I am not sure if there is a lower age for determining constipation, but soiling and encopresis would have little meaning in an infant who has not been toilet trained.


Soiling indicates the involuntary passage of stools, often with a loose consistency. It is often associated with fecal impaction.


Encopresis is the voluntary or involuntary passage of stool:

(1) somewhere other than into a toilet (underpants, pajamas, other)

(2) after the age of 4

(3) at regular intervals (at least 2 times per week according to Benninga et al; at least once a month according to Felt et al)

(4) in the absence of any organic cause.


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