Extensive investigations are rarely indicated. All investigations should be guided by the history and clinical findings. Table 3 lists the appropriate investigations for different conditions.
| Table 3. Investigations For The Child With Constipation |
| SIMPLE CONSTIPATION |
| • None |
| SEVERE CONSTIPATION WITH ENCOPRESIS |
| • Flat plate x-ray of abdomen to assess fecal loading if results of abdominal examination are negative and rectum is empty |
| • Routine urinalysis and urine culture |
| CONSTIPATION AND FAILURE TO THRIVE |
| • Thyroid function studies |
| • Complete blood count |
| • Erythrocyte sedimentation rate |
| • Stool for occult blood and leukocytes |
| CONSTIPATION AND URINARY TRACT INFECTIONS |
| • Renal ultrasound |
| • Voiding cystourethrogram |
| SUSPECTED HIRSCHSPRUNG’S DISEASE |
| • Barium enema: limited study of an unprepared bowel |
| • Prompt referral to a pediatric surgeon for rectal suction biopsy and treatment |