Childhood constipation and faecal incontinence account for about 25% of paediatric gastroenterologists’ work and are within the top 10 most common problems for general paediatricians.¹ One way of describing the contribution that members of the therapeutic team make when attempting to help is to follow a typical case history (or patient journey) through the years of evolution and then resolution of the problems. At each stage the likely diagnoses will be discussed together with information on the epidemiology of the more common disorders in the differential diagnosis. The conditions causing difficult defecation in children are similar to a number of childhood problems in the ease with which vicious physical and psychological cycles develop. Unfortunately, this is an area with a shortage of evidence and a plethora of opinion. However, a description of the practice of our team members may provide the reader with valuable insights gained from working with thousands of children with nearly as many variations on the typical constipation theme. Examples of guidelines will be presented with as much supportive evidence as we find. By the end of this article we hope that the reader may feel empowered to set up or contribute to a team that actively manages the problems described with stronger defences against the negative feelings that the chronicity and uncertainties of the problems frequently induce.

NOMENCLATURE

It is impossible to make sense of the literature without being aware of the lack of consensus on the meaning of the words used for the common defecation problems. Attempts have been made to establish a terminology as part of the Rome II consensus on terms in paediatric gastroenterology.² However, in practice the terms failed to describe effectively a high proportion of children attending.³ For the purpose of this paper, the following terms and their definitions …