The number of children seen in primary care for treatment of constipation has nearly doubled in the past decade.  The article Primary Care: Constipation and Encopresis Treatment Strategies and Reasons to Refer gives an overview of the constipation and encopresis treatment approaches that primary care physicians use and looks at why they might refer particular patients to pediatric gastroenterologists.  A convenience sampling questionnaire including 91 primary care providers revealed that most recommendations to patients included medication management combined with diet changes.  The most common reason for referral was lack of response to treatment.

The findings from the study showed that these primary care providers utilize clinical guidelines recommended by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) for medication management, however not for diet management.  The NASPGHAN recommends a well balanced diet, however, the majority of primary care providers in the study instructed families to increase fiber, eliminate “constipating” foods, and reduce dairy from their child’s diet.

Studies show conflicting data regarding the benefit of fiber supplement and a time-limited trial of removing cow’s milk from the diet is recommended only if the child is not responding to traditional therapies.  One particular article referenced in this study stated that there is no proof that changing diet reduces functional constipation, and diet modifications can be especially difficult to follow if a child is already a selective eater.

By determining common reasons for referrals to specialists, this study could assist primary care providers in better managing constipation and encopresis and lead to education that would potentially decrease the need for those referrals.  There are many children who benefit from seeing a specialist, however if the primary reason for referral is unresponsiveness to treatment, perhaps modifying the treatment regimen in the primary care setting to be more consistent with NASPGHAN recommendations would make sense in a number of cases.  This may ultimately decrease the number of referrals needed, help manage overall healthcare costs and help with consistent care for families by keeping with their primary care provider when possible.

The UCanPoopToo program offers additional information on medication management and diet, and the program content is presented in a kid-friendly, interactive manner that allows both parents and children to relate.  Other aspects are addressed as well including toileting, hygiene, social issues and much more.  To learn more about how the UCanPoopToo program may benefit your child, visit