Document Type : Original Article


1 Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran

2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Gastroenterology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

5 Department of Biostatistics, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Back ground: Constipation is a prevalent problem in pediatric patients and one of the ten most common pathological conditions visited by general pediatricians (1). It accounts for up to 25 percent of referrals to a pediatric gastroenterologist. Therefore, this study was done to evaluate the effects of a nurse-based education program on reducing the symptoms of chronic functional constipation in children (2).
Methods: This clinical trial study was conducted on 95 children (48 control and 47 intervention group), aged 3 to 14 years old, and selected randomly out of the patients referred to Imam Reza Clinic affiliated to Shiraz University of Medical Sciences in 2014. The control group only received the usual treatment prescribed by the physician; however, the intervention group received a comprehensive nursing program. Then, having completed Rome III Criteria Form immediately after the intervention for one month, two months, and three months, we collected the required data. The significance level in this study was 0.05.
Results: The mean age of the samples was 78.30±32.52 months in the intervention group and 74.60±32.26 months in the control group. Also, the average weight of children in the intervention group was 23302.17±12034.96 grams and in the control group 21376.09±9351.80 grams. 18% of the samples from the intervention group and 22% of the control group were males. With a follow-up of 3 months, the percentage of changes in the intervention group in items 1 (two or fewer defecation in the toilet per week) and 4 (history of painful or hard bowel movement) was 48.9% and 74.5%, respectively, and in the control group 22.9% and 52.1%, respectively. Therefore, positive changes in the intervention group were better than the control group. The difference between these two variables was statistically significant (p-value <0.05). In other dimensions of the Rome III criteria, there was no significant difference between the intervention and control groups (p value> 0.05), despite changes in the percentage of items in different periods of 1, 2, and 3 months.
Conclusion: The findings of this study indicate that nursing education programs have a desirable effect on the reduction of some symptoms of chronic functional constipation based on Rome III criteria in children aged 3-14 years.


1.         Xinias I, Mavroudi A. Constipation in Childhood. An update on evaluation and management. Hippokratia. 2015;19(1):11.
2.         Zar-Kessler C, Kuo B, Belkind-Gerson J. Botulinum toxin injection for childhood constipation is safe and can be effective regardless of anal sphincter dynamics. Journal of pediatric surgery. 2018;53(4):693-7.
3.         Mason D, Tobias N, Lutkenhoff M, Stoops M, Ferguson D. The APN's guide to pediatric constipation management. The nurse Practitioner. 2004;29(7):13-21.
4.         Pijpers MA, Bongers ME, Benninga MA, Berger MY. Functional constipation in children: a systematic review on prognosis and predictive factors. Journal of pediatric gastroenterology and nutrition. 2010;50(3):256-68.
5.         van Dijk M, Benninga MA, Grootenhuis MA, Last BF. Prevalence and associated clinical characteristics of behavior problems in constipated children. Pediatrics. 2010;125(2):e309-e17.
6.         Rajindrajith S, Devanarayana NM. Constipation in children: novel insight into epidemiology, pathophysiology and management. Journal of neurogastroenterology and motility. 2011;17(1):35-47.
7.         Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best practice & research Clinical gastroenterology. 2011;25(1):3.
8.         Loening-Baucke V. Prevalence rates for constipation and faecal and urinary incontinence. Archives of disease in childhood. 2007;92(6):486-9.
9.         Rafee M, Fazolah Zade H, Mansoori A. The risk factors opf childhood constipation in Tabriz Children's Hospital. Tabriz Nursing & Midwifery Journal. 2008;12:46-52.
10.       Karami H, Mousavi A, Khademloo M, Soleimani F. Etiology of chronic constipation and related causes in children referred to Boo-Ali Sina Hospital in Sari between 2006 and 2007. Journal of Birjand University of Medical Sciences. 2010;16(4):51-6.
11.       Culbert TP, Banez GA. Integrative approaches to childhood constipation and encopresis. Pediatric Clinics of North America. 2007;54(6):927-47.
12.       Karami H, Sahebpour A, Paknezhad K, Shokohi L, Shahmohammad S. Botulinum toxin injection in children with costipation caused by internal sphincter achalasia. J Masand Univ Med Sci. 2012;22:26-33.
13.       Pashankar DS. Childhood constipation: evaluation and management. Clinics in Colon and Rectal Surgery. 2005;18(2):120.
14.       Burnett C, Juszczak E, Sullivan P. Nurse management of intractable functional constipation: a randomised controlled trial. Archives of disease in childhood. 2004;89(8):717-22.
15.       Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130(5):1527-37.
16.       Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130(5):1519-26.
17.       Aghapour A, Aarabi M, Semnani S, Besharat S, Roshandel G, Pasha H, et al. Polyethylene glycol versus lactulose in chronic pediatric constipation. Govaresh. 2010;15(1):20-5.
18.       van Dijk M, Bongers ME, de Vries G-J, Grootenhuis MA, Last BF, Benninga MA. Behavioral therapy for childhood constipation: a randomized, controlled trial. Pediatrics. 2008;121(5):e1334-e41.
19.       Tabbers MM, Boluyt N, Berger MY, Benninga MA. Nonpharmacologic treatments for childhood constipation: systematic review. Pediatrics. 2011;128(4):753-61.
20.       Voskuijl WP, Heijmans J, Heijmans HS, Taminiau JA, Benninga MA. Use of Rome II criteria in childhood defecation disorders: applicability in clinical and research practice. The Journal of pediatrics. 2004;145(2):213-7.
21.       Brazzelli M, Griffiths P. Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children. Cochrane Database Syst Rev. 2006;2.
22.       Cox DJ, Sutphen J, Borowitz S, Kovatchev B, Ling W. Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis. Annals of Behavioral Medicine. 1998;20(2):70-6.
23.       Rosen R, Buonomo C, Andrade R, Nurko S. Incidence of spinal cord lesions in patients with intractable constipation. The Journal of pediatrics. 2004;145(3):409-11.
24.       Loening-Baucke V. Functional fecal retention with encopresis in childhood. Journal of pediatric gastroenterology and nutrition. 2004;38(1):79-84.
25.       Ismail N, Ratchford I, Proudfoot C, Gibbs J. Impact of a nurse-led clinic for chronic constipation in children. Journal of Child Health Care. 2011;15(3):221-9.