Functional constipation is a common group of clinical symptoms in childhood rather than a separate disorder. Its exact pathogenesis is not known. In children’s constipation, most of the cases belong to functional constipation, according to the pediatric outpatient statistics of the University of Thowa and Heston University Hospital, the incidence of constipation in children is 3% to 8%, of which 90% to 95% is functional constipation; this disease in children, although the incidence of many, although in the early stage of the disease is easy to treat, but due to the symptoms of the lighter, easy to be ignored by the family, often to the onset of the disease for a long period of time before they begin to This makes treatment very difficult. Severe constipation is often combined with abdominal distension, abdominal pain and abdominal masses, and even incontinence. It has a greater impact on the social activities, psychological development and academic performance of the children, leading to a decline in the quality of life. The cause of idiopathic constipation is not clear, but may be related to the following factors. 1, dietary factors Diet is too little, too refined, lack of fiber, drinking water and other food ingredients are not suitable and other factors can lead to constipation. Morais observed on the diet of constipated children and found that the calorie intake of the affected group was 1526±585 calories/day, which was significantly lower than that of normal children. The caloric intake of the group was 1526±585 calories/day, significantly lower than that of normal children. High-fiber diet is less likely to cause constipation, because the fiber polysaccharides in the food can not be digested, some of them can be decomposed by cellular fermentation in the intestinal tract, and the end products are short-chain fatty acids, nitrogen, CO2 and methane, which can stimulate peristalsis to strengthen the colon, and the undigested fibers can increase the volume of fecal matter, retaining water, so that feces are soft, shorten the intestinal running time, and reduce the pressure in the colon. Morais reported that children with constipation had a significantly lower than normal intake of dietary fiber, with non-absorbable fiber having a more pronounced deficiency. Studies of regions with different dietary profiles have also found that the incidence of constipation is significantly lower in regions with high dietary fiber intake. However, the mechanism by which fiber plays a role in the development of constipation is not well understood, and it has also been reported that the development of constipation is not related to fiber. Other inappropriate food composition is also an important factor in the production of constipation, if the food contains a lot of protein and less carbohydrates, the intestinal decomposition of protein bacteria than fermentation bacteria, intestinal contents of the fermentation is less, the stool is alkaline, dry, and less frequent. If the fat and carbohydrate content is increased, the stools are more frequent and soft. After eating large amounts of calcified casein, the stools tend to be dry and constipated.Quinlan’s comparison of the stools of human-fed infants with those of breast-fed infants showed a marked increase in hardness and in the solid content of the feces. Minerals and fat content increased significantly, sugar content decreased significantly, fat content is mainly calcium soap increased significantly. morais reported constipation children breastfeeding time is significantly shorter than normal children group, dietary fat and iron content is significantly lower than normal children. 2, abnormal defecation habits due to various reasons so that the child failed to develop good defecation habits, when the feces into the rectum to produce stool, the child does not want to go to the toilet to defecate, but consciously inhibit defecation, often take a standing position, the thighs are clamped, vigorously contraction of the pelvic floor muscles and external anal sphincter to close the anus, feces in the rectal retention, caused by the adaptive expansion of the rectal wall to reduce the pressure of the rectum, the urge to stool disappears. The urge to poop disappears. The feces gradually accumulates in the rectum and becomes dry and hard due to water absorption, which makes it difficult to pass feces and causes painful defecation. The child’s fear of defecation further inhibits defecation, which makes the feces retained even drier and harder, forming a vicious circle, leading to fecal impaction, rectal overdistension, and outflow of liquids from the area around the fecal matter, which leads to defecation and fecal incontinence. Children with idiopathic constipation have varying degrees of fecal retention in 40-100% of children. There are many reasons for children to inhibit defecation, mainly in the following aspects: 1, wrong training of defecation habits, parents of pediatric defecation habit training too early, forcing children to defecate too early in the adult bucket, so that children have fear of fear, at the same time, due to the height of the bucket is not appropriate, defecation force difficulty, parents of pediatric defecation training is too strict or overly indulgent, so that children have a rebel mentality, reluctant to on-time The child will not be willing to defecate on time. 3, defecation pain, fear of defecation The most common reason is anal fissure, due to the existence of anal fissure, defecation obvious pain, and may appear bloody stool, so that children inhibit defecation, and the formation of a vicious circle. 2 months to 2 years of age of children anal fissure incidence is the highest. In addition, anal surgery, perianal infection, perianal skin diagnosis can lead to painful defecation. 4, living environment and habit change due to moving, family increase in population, long-distance travel, etc. make the child familiar with defecation environment suddenly change. Neglect defecation, children are too greedy to play, no time to defecate, afraid of being late for class, do not take time to defecate, do not dare to ask the teacher for permission to go to the toilet during class, and so on. Psychological factors Children with constipation often suffer from various psychological abnormalities, including anxiety, lack of self-confidence and competitiveness, weak self-esteem, isolation and emotional disorders. Children with constipation are reported to be inattentive, hyperactive, and resistant to treatment. Children with constipation have a high prevalence of behavioral problems as measured by the Children’s Behavior Scale, and Rappaport reported that behavioral scores of children with constipation correlated significantly with clinical symptoms and the results of manometry, electromyography, and colonic transport tests. Emotional events (e.g., first time at school, sudden transition to a new living environment, parental divorce) can trigger the onset of symptoms in children with constipation. However, the role of psychological factors in the development of constipation has not yet been confirmed. On the one hand, because the behavioral problems of children with constipation are only a tendency and not very serious, many indicators do not meet the diagnostic criteria of psychological abnormality, and at the same time, many psychological abnormalities may be the result of constipation, not the cause of constipation. On the other hand, children with constipation have an early onset, 38-65% of children with the first onset of the disease before 6 months, some people report that 40% of constipation can be traced back to 1 month before birth, at such a young age by psychological factors. 6.Genetic factors Children with constipation often have symptoms after birth and have obvious family history. Bellman compared children with constipation and normal children and found that 1.3% of the mothers of children with constipation, 15% of the fathers of children with constipation and 8.7% of the brothers of children with constipation had a history of constipation, which was significantly higher than that of the control group. Morais also had similar reports. Taylor reported that the incidence of constipation was 6 times higher in the siblings of children with constipation than in the brothers. In addition, some studies found that children with constipation have special types of fingerprints, which proves that constipation has a certain genetic predisposition. 7, hormone levels Stern reported that children with constipation pancreatic polypeptide levels in the postprandial increase is very obvious, and early peak secretion, while gastric motility levels in the postprandial response is very low. In adult patients with constipation, prolactin can be elevated, and blood and urine estrogen can be lowered. This suggests that changes in hormone levels in the body can be involved in the occurrence of constipation. 8, food allergy Iacono 27 cases of constipation for an average age of 21 months of children given to remove milk protein diet, 1 month after 21 cases of symptoms disappeared, and again given to the milk protein-containing diet after the recurrence of symptoms, and found that serum immunity indexes there are abnormalities, there are 2 cases of children with colonoscopy to take pathology, found that the intestinal wall has mononuclear cell infiltration, presumably food allergy may be the cause of constipation. 9, urinary tract infection As constipated children often show abnormal urinary tract function, many children have a history of urinary tract infection, that constipation may be a secondary change after urinary tract infection. 10, sexual abuse In recent years, it has been reported that sexual abuse may be related to the occurrence of constipation. A study showed that 44% of women with defecation dysfunction had a history of sexual abuse in childhood. [Pathology] 1, colon The use of colonic transport test can determine the function of colonic peristalsis, the literature will report the results of the synthesis of the results in the constipation of children in 20 ~ 40% of the children with normal colon transport time, 13 ~ 25% of the children with the slowing of the whole colon transport, 25 ~ 29% of the right then the slowing of colonic transport, 34 ~ 38% of the slowing of the transmission of the recto-sigmoid colon. Bassotti adult constipation patients. Bassotti adult constipated patients underwent 24 hours colon manometry, found that compared with the control group colon group peristalsis was significantly reduced, postprandial group peristalsis was also significantly reduced.Slater adult slow transmission constipated patients colon smooth muscle to cholinergic stimulation with higher sensitivity than the normal colon smooth muscle, suggesting that this type of constipated patients with the presence of colonic smooth muscle pathology.Brien adult constipated patients underwent colonic manometry, found that There was no difference from normal during fasting, and the pressure elevations in the descending and sigmoid colon were significantly lower than normal 2 hours after meals. Through immunohistochemical studies, it was found that patients with constipation had abnormalities in the structure of the colonic intermuscular plexus and the innervation of the colonic circular muscle. Summit et al. also found that patients with slow-transmission constipation had a significantly lower content of vasoactive peptide and substance P in the wall of the sigmoid colon, which suggests that colonic transmission disorders may be associated with dysfunction of vasoactive peptide and substance P-ergic neurons in the intestinal wall. Yang Shan reported that rectal enkephalins were significantly higher in patients with constipation. There are fewer studies on the changes in the organization and structure of the colon in children with slow-transmission constipation. Many studies have shown that children with constipation have decreased rectal sensory thresholds and increased rectal compliance.Medici reported that the rectal sensory threshold was 26±1.8 ml in normal people when the balloon was inflated, 57±7 ml in normal people with colon transmission, 85.2±7.2 ml in patients with chronic transmission of colon, and 115±12.5 ml in patients with fecal retention of the sigmoid colon in the rectum.The rectal sensory thresholds were also found to be increased in patients with chronic transmission of rectal feces through electrical stimulation of the rectal mucosa.The rectal sensory thresholds of the patients with chronic transmission of feces in the rectal colon were also increased in patients with chronic transmission of rectal feces. Loening found that the latency of cerebral neural evoked potentials recorded by expanding the rectal balloon was significantly prolonged in constipated children, suggesting that the afferent pathway of rectal sensation may be abnormal.Schouten found that the intrarectal pressure rise during defecation in constipated adults was significantly lower than that in normal subjects.Groti performed 24-hour rectal pressure monitoring in constipated adults and found that rectal dynamics were significantly reduced. Groti’s 24-hour rectal pressure monitoring in adults with constipation revealed a significant decrease in rectal dynamics. Measurement of rectal pressure in adults with constipation found that there was no significant difference between fasting and normal, rectal pressure elevation was significantly lower than normal after meals, and rectal pressure elevation after intramuscular injection of neostigmine was also significantly lower than normal, which indicate that there are significant abnormalities in rectal function in patients with constipation. Anal canal pressure measurements in constipated children showed elevated pressure in some and decreased pressure in others. Thirty-eight percent of the constipated patients were reported to have significantly higher than normal anal canal pressures, and Meunier reported that children with constipation combined with fecal incontinence had significantly lower than normal anal canal pressures. As the constipation resolves, the pressure returns to normal. The rectovaginal relaxation reflex is an important reflex to maintain normal defecation physiology, and it is also abnormal in children with constipation; Loening reported that the threshold of rectovaginal relaxation reflex was higher than normal in children with constipation, and the degree of anal canal relaxation was significantly lower than normal. Clayden found that the waveform of the rectal relaxation reflex was abnormal in children with constipation, and Hosie found that the internal anal sphincter was thickened in children with constipation through ultrasound examination of the anal canal. These results suggest that the internal sphincter of children with constipation may have certain pathological changes. 3, defecation power The smooth completion of the defecation process requires the coordinated movement of the pelvic floor muscles, normal defecation, the external anal sphincter and puborectalis muscle should be in a state of relaxation, increase the angle of the rectum and anus, so that the feces passes through smoothly. Recent studies have shown that in many children with constipation, the external anal sphincter and the puborectalis muscle do not relax during defecation, but contract paradoxically, decreasing the angle of the rectum and anus and making defecation difficult.Loening has reported that this abnormality is present in 50% of children with constipation, and that children with this abnormality are poorly responding to conservative treatments. The exact etiology of this abnormality is not known, but abnormalities in the nerves innervating the external anal sphincter may be one of the causes of the abnormal dynamics of defecation. Abnormal defecation power was found in defecography, the anal canal was not open when the child defecated, and the rate of evacuation was significantly reduced in the balloon evacuation test. 4.Spinal nerve Kubota recorded spinal evoked potentials through electrical stimulation of the anus and found that the latency period was significantly prolonged. Vaccaro reported that 31.4% of adult patients with constipation had significantly prolonged terminal latency of the nerves in the pubic area. Imaging studies also revealed a higher than normal incidence of occult spina bifida and spinal cord embolism in children with constipation. These all indicate that children with idiopathic constipation have spinal cord nerve abnormalities. 5.Urinary system Children with idiopathic constipation deeply combined with urinary incontinence and enuresis, and with the reduction of constipation symptoms and get better, the etiology of this phenomenon is still unclear, some people think that with the fecal retention of the bladder compression, so that the bladder outflow tract obstruction caused by the fecal retention of the fecal retention of the bladder. Malone on 39 cases of idiopathic constipation of the children for pyeloureteral urography, found that there are 20% of the vesicoureteral reflux, 31% of the bladder lining not smooth, 40% have urethra The inner wall of the bladder was not smooth in 31%, urethral lengthening was present in 40%, and the shape of the bladder base was abnormal in 66%. Urodynamics also suggests instability of the urethra in patients with constipation. Watier’s study of 54 adult patients with severe constipation found that 30% had upright hypotension, 15% had unexplained breast milk overflow, and objective tests revealed that the patients had significantly elevated resting pressures in the upper esophageal sphincter, paradoxical contractions during swallowing, abnormal peristalsis, and significantly decreased function of the lower esophageal sphincter. The bladder pressure was abnormally elevated after administration of cholinergic drugs. Zhou Junfu reported that erythrocyte superoxide dismutase activity was significantly reduced, plasma lipid peroxide and erythrocyte lipid peroxide content were significantly increased in idiopathic adult patients with constipation, and changed with the prolonged course of the disease, indicating that the oxygen radical reaction and lipid peroxidation reaction in patients with constipation were significantly enhanced. It suggests that patients with constipation may have pathological changes in organs other than the intestines. Clinical manifestations] 1, clinical manifestations idiopathic constipation in children is mainly manifested as a decrease in the number of bowel movements, defecation difficulties, but also the main diagnostic basis of constipation, other clinical manifestations are related to the two symptoms of the intestinal local symptoms and systemic symptoms. ① Decrease in the number of bowel movements: the number of bowel movements in children gradually decreases with age, 4-6 times/day for newborns in the first week after birth, and 1-2 times/day for 4-year-old children. Epidemiologic surveys show that 97% of children younger than 4 years of age have at least one bowel movement every two days, and children older than 4 years of age have at least three bowel movements per week. Therefore, less than or equal to 3 bowel movements per week is considered abnormal in children younger than 4 years of age.Leoning reported that 58% of children with constipation had a decreased number of bowel movements. Due to the low frequency of defecation, the feces stay in the intestine for a long time, and the water is fully absorbed and becomes dry and hard, which makes it difficult to pass. In severe cases, the intestinal wall may be necrotic due to the compression of the fecal mass, and fecal ulcers, or even intestinal perforation and total peritonitis, may occur. If the colon transmission obstacle, the feces is manifested as hard small fecal balls like single feces, if the rectosigmoid colon has stool retention, it is manifested as a larger diameter hard bar-shaped fecal matter, 75% of children with constipation have thickened fecal strips. Sometimes the child can usually row a very small amount of feces, interval of a week or half a month after the emergence of a concentrated defecation, a lot of volume, often fill the entire toilet, not defecate when the body discomfort, food and drink is not vibrant, immediately after the discharge of feces, feel relaxed, food and drink exuberant. ② abnormal defecation: about 35% of the children with constipation showed abnormal defecation effort, defecation force time is longer, it is generally believed that if the time of defecation force time is more than 25% of the entire time of defecation is regarded as difficult to defecate, defecation difficulty is sometimes due to hard and dry fecal matter, the amount of feces, and sometimes because of the abnormal power of defecation, fecal matter is very soft can not be discharged. Difficulty in defecation may be characterized by postures such as standing on tiptoe, stiff legs, forward bending of the back, and grasping furniture with both hands. Older children often hide alone in the toilet or another room, half-squatting and shaking their bodies vigorously, and defecation lasts for a long time. About 50-86% of children with constipation show pain during defecation, 6% have bloody stools, and some have a feeling of incomplete defecation. Some children may develop anal fissures as a result, which makes them fearful of defecation and aggravates the difficulty in defecation. Due to the fear of defecation or failure to develop good defecation habits, 35-45% of children with inhibition of defecation, when the intention to defecate does not go to the toilet to defecate, but to force the contraction of the anal sphincter and the gluteus maximus muscle, to prevent defecation. Incontinence: The incidence of defecation and incontinence in children with constipation is very high, with reports varying from 50 to 90%. It is difficult to assess incontinence in young children because of their poor ability to control defecation at will. Therefore, incontinence is strictly defined clinically as the passing of varying amounts of regular stool to places other than the prescribed defecation site, such as the underpants or the floor, in children older than 4 years of age and in the absence of any clear organic pathology. Soiling is defined as unintentional soiling of the underwear. Constipation combined with incontinence is often thought to be due to overflow incontinence caused by fecal retention, but it has also been reported that the resting anal canal pressure is significantly lower in constipated children with constipation combined with incontinence than in constipated children without incontinence, and that the contractile reflexes of the external anal sphincter muscle are abnormal after expansion of the balloon, which may play a role in the development of constipation combined with incontinence. Other abdominal symptoms Children with constipation often present with gastrointestinal symptoms such as abdominal pain, bloating, loss of appetite, and vomiting. Leoning reported that the incidence of abdominal pain in children with constipation is 10-70%, abdominal distension is 20-40%, loss of appetite is 26%, and vomiting is 10%. Abdominal pain is often located in the left lower abdomen and umbilicus, is paroxysmal, non-disseminated, and can be relieved by hot compresses or defecation, mainly due to intestinal spasms triggered by fecal obstruction. Children with abdominal distension often suffer from loss of appetite and discomfort, which can be relieved after defecation or evacuation. ⑤ Psychological abnormalities The incidence of psychological abnormalities in children with constipation is high, which may be primary or secondary, and the exact mechanism is still unclear, mainly manifested as anxiety, lack of self-confidence, psychological vulnerability, isolation, and inattention. The children are less likely to participate in group activities, do not like to make friends, are introverted, and often complain of physical discomfort. The children’s psychological and physical development and social communication are significantly affected, and the quality of life is significantly reduced. ⑥ urinary abnormalities Children with constipation are often combined with the urinary tract, abnormal Loening investigation 234 idiopathic constipation children found that 29% of the children with daytime urinary incontinence, 34% of the nighttime enuresis, 11% of the history of urinary tract infections, the incidence of urinary tract infections in girls is 33%, 3% of the boys. The incidence of urinary tract infection was 33% in girls and 3% in boys. After 12 months of follow-up, it was found that with the cure of constipation, the symptoms of daytime incontinence disappeared in 89% of the children, nocturnal enuresis disappeared in 63% of them, and urinary tract infection disappeared in all of the children. Physical examination ①Abdominal examination Palpation: mainly observe whether the child has abdominal distension, intestinal pattern and peristaltic wave. Palpation: the left lower abdomen can have deep pressure pain, about 30 to 50% of children with constipation can be touched painless mass, slightly active, this is due to the intestinal tract due to retention of feces, individual children can touch the hard fecal stone. ② anal examination auscultation: to observe the presence of anal fissure, fistula, opening ectopic, hemorrhoidal prolapse, inflammation of the anus, dirty stool, blood. Rectal palpation: it plays an important role in the diagnosis, differential diagnosis and treatment of constipation. First of all, you can check the tension of the anal canal, high tension can suggest that there is spasm of the internal sphincter, low tension can suggest the existence of internal and external sphincter neurological abnormalities, ask the child to make a bowel movement can check whether there is an abnormal contraction of the puborectalis muscle and external anal sphincter, ask the child to force the contraction can check the strength of the external anal sphincter, anus can not be passed through the finger suggests that there is an anal stenosis, the touch of the rectum and hard feces suggests that there is fecal retention, the individual does not have feces, but can not pass the fingers. Individual children’s feces are not very hard, but very sticky, and sometimes hard fecaliths can be touched. 3, auxiliary examination ① rectal anal tube manometry: can check the rectal sensory function, rectal compliance and internal and external anal sphincter pressure, rectal anal tube relaxation reflex, etc. to provide objective indicators reflecting the function of the rectum and the internal and external anal sphincter, to determine the degree and type of constipation, and to provide a reliable and objective basis for determining the effective treatment program. ② Defecography: X-ray defecography can provide a clear image of the rectum and anus, determine the presence of rectal intussusception, anterior prolapse and other anatomical abnormalities, and the angle of the rectum and anus in the state of resting contraction and defecation can determine the strength of the pubic rectum and anus and the presence of abnormal contraction of the pubic rectus muscle. Rectal-anal angle displacement can determine the function of the pelvic diaphragm, isotope defecography can provide objective indicators reflecting the function of defecation such as residual rate, half-empty time and emptying rate. ③Colon transmission test: it can observe the peristaltic function of each section of colon, determine whether there is slow transmission type constipation or outlet obstruction constipation, and provide objective basis for treatment. ④Electromyography: conventional electromyography can provide objective indexes for determining defecation power such as spasm index, and biofeedback treatment can be carried out for abnormal defecation power by using electromyography. Neurophysiological test can provide objective indexes for determining anorectal nerve conduction function such as perineum-anal reflex, spinal cord-anal reflex, cauda equina evoked potential, cerebral nerve evoked potential, and so on. ⑤ Endoscopy: it can observe the changes in the mucosa of colon and rectum, which is of great significance to exclude organic diseases. (6) Tissue biopsy: to determine the rectal tissue structural changes and the development of intestinal wall neurons, except for congenital megacolon. [Diagnosis] Before diagnosing idiopathic constipation, other organic diseases with constipation symptoms should be excluded first, and different pathological types of idiopathic constipation should be distinguished in detail, so that the treatment can be targeted to improve the efficacy. Therefore, detailed history, targeted auxiliary examination, clear diagnostic criteria and accurate differential diagnosis are very important. 1, medical history ① disease: including the time of onset, duration, cause of disease, aggravating or alleviating factors. ② the extent of the disease: including the number of stools, the nature of the shape, shape, hardness, etc. whether mixed with blood or purulent secretions, whether defecation is difficult, whether there is a desire to defecate, whether there is a feeling of impurity after defecation, can distinguish between exhaust and defecation, whether there is inhibition of defecation, fear of defecation, whether there is dirty stools, incontinence, and so on. Accompanying symptoms: whether there is abdominal pain, abdominal distension, loss of appetite, emaciation, weight loss, nausea, vomiting, fatigue, urinary incontinence, etc. Diet: whether the diet composition is reasonable, whether partiality, how much water is consumed, less infants should be asked whether they are breastfed or artificially fed, and whether complementary foods are added. ⑤Treatment: whether they have been treated, what kind of treatment, whether they have been trained to defecate, whether they have used laxatives, and how effective the treatment is. (6) Psychological factors: whether anxiety, hyperactivity, depression, participation in social activities, study and family life. (vii) Past history: history of previous illnesses, surgeries, medications, family history, genetic disease, etc. If there are conditions, it is best to let the child write defecation diary records, defecation, Plas use of recollection methods to ask for a history of the method and write a defecation diary method of accuracy comparison, found in the number of defecation and defecation, ask for a history of the method is very inaccurate, coupled with the history of the child is often your mother’s statement, the accuracy of the worse. 2, auxiliary examination results as an important reference 3, diagnostic criteria: In 1997, the international functional gastrointestinal disorders (FGIDs) in children formulated diagnostic criteria. 1999 closer to the characteristics of children’s Rome II criteria published, became a unified diagnostic criteria for children’s FGIDs. 2006, the Rome II criteria for the second revision, proposed the Rome III diagnostic criteria. The diagnostic criteria for FC in children between 4 and 18 years old are as follows: no symptoms of irritable bowel disease (IBS), and at least two of the following criteria are fulfilled within two consecutive months, namely: (1) less than two bowel movements per week; (2) at least one fecal incontinence per week; (3) active inhibition of defecation; (4) abdominal pain or history of intestinal cramps; (5) retention of large fecal matter in rectum; (6) large stools or even blockage of stool outlets. A weekly record of the above symptoms for at least 2 months prior to diagnosis. Compared with the Rome II criteria, Rome III reduces the history of constipation in the Rome II diagnostic criteria from 3 months to 2 months, with the rationale that although constipation has a slow onset, treatment is significantly more effective when the diagnosis is made within 2 months than when the diagnosis is made after 3 months. In addition, Rome III eliminated the diagnostic criteria for functional fecal retention, referring to functional constipation and functional fecal retention collectively as functional constipation. The criteria for FC in children under 4 years of age are: (1) less than 2 bowel movements per week; (2) at least 1 bowel incontinence per week after potty training; (3) actively inhibiting bowel movements; (4) history of abdominal pain or intestinal cramps; (5) retention of large fecal pellets in the rectum; and (6) bulky stools that block the exit of the toilet seat. Accompanying symptoms include irritability, decreased appetite, or abdominal fullness with small amounts of food, which disappears rapidly after defecation. This criterion further shortens the duration of constipation to 4 weeks, emphasizing the importance of early diagnosis of constipation. Among the above criteria, so that incontinence and retention of large fecal mass in the rectum are the most important. Fecal incontinence occurs as a result of progressive retention of excessive fecal matter in the rectum, leading to pelvic diaphragm muscle fatigue and reduced anal sphincter sphincter mechanism, and is the hallmark of severe FC. The so-called functional fecal retention is no longer recognized by specialized physicians and is used as a reference indicator in this standard.