I. Definition of chronic constipation Pediatric chronic constipation is a clinical symptom caused by a variety of factors, manifested as a reduction in the number of stools, dry and hard stools, and difficult or poor defecation. Can be caused by many factors, such as smooth muscle origin, neurogenic, metabolic or endocrine disorders, called secondary constipation; when these factors are excluded after the constipation is called functional constipation. Foreign data show that the incidence of pediatric constipation 3%-8%, 90%-95% of which is functional constipation. Domestic epidemiological surveys show that the incidence of functional constipation in children aged 2-14 years is 3.8%, higher in urban areas than in rural areas, and higher in girls than in boys. Functional constipation is a gastrointestinal motility disorder that affects the quality of life and physical and mental development of children, often troubling children and their parents. Second, the common causes of chronic constipation 1, unreasonable dietary structure: protein food intake, such as meat, eggs, milk; carbohydrate-containing food (staple food) intake and too fine (less coarse grains); insufficient intake of dietary fiber food, such as vegetables, beans, fruits. In addition, drinking less water is also an important reason. 2, intestinal flora dysbiosis: the intestinal tract beneficial bacteria reduced, such as bifidobacteria, lactobacillus and Streptococcus faecalis, and more harmful bacteria, such as Gram-negative bacilli, Clostridium difficile and other spoilage bacteria, and produce a large number of enterotoxins and harmful substances, so that intestinal peristalsis slowed down, intestinal function disorders. 3, environment, life habits change: after entering kindergarten, due to the unfamiliar environment, lifestyle changes, some children try to avoid defecation in kindergarten because they are afraid; school-age children often try to inhibit defecation due to factors such as classes. The stool is often stored in the rectum, and over time, the pelvic floor muscle becomes fatigued and causes weak contraction and relaxation of the anal sphincter. The liquid fecal juice leaks from around the fecal mass, and the feces contaminates the underwear or causes fecal incontinence. Sometimes accompanied by abdominal pain, decreased appetite, etc. 4, less activity: nowadays the content and rhythm of social life changes, children’s daily activity is also affected, especially children over 7 years old, most of the time during the day to study in class, home to do homework, watch TV, operate the computer, etc., so that the amount of activity is greatly reduced. 5, lack of formal defecation habit training: defecation habit training refers to the most active period of gastrocolonic reflexes within half an hour after meals, purposely make children go to the toilet (or sit on the potty, etc.), gradually develop good defecation habits, so that the transition from reflex defecation to regular defecation to adapt to the social order, to prevent the occurrence of functional constipation good life training methods. It is appropriate to start at about 18 months of age. 6, mental factors 20% of children with mental factors, some scholars call it mental constipation. Before the occurrence of constipation encountered unexpected events, such as family disagreement, parental divorce, moving to a new home, changing schools, facing exams or promotion, etc., the child’s poor mood, anxiety or depression, affecting normal defecation. Third, functional constipation typing to colon and rectal anal dynamics characteristics, the functional constipation is divided into 3 types 1, slow passage type: refers to the contents of the colon due to colon power disorders, so that the contents of the colon stagnant or slow passage of the colon constipation. The patient’s symptoms are mostly low frequency of defecation, hard stool texture, and no bowel movement. 2, exit obstruction type: may be due to abnormal function of sensation or rectum and anus, with normal colonic transmission function. Clinical manifestations are difficulty in defecation, anorectal obstruction, and the need for hand assistance during defecation. 3, mixed type: with the characteristics of the above two types, or both are atypical. 4, the diagnosis of chronic constipation 1, in order to exclude secondary constipation, a comprehensive and systematic evaluation of the child is very necessary. The main observations are the presence of organic injuries, metabolic and systemic diseases, and, if necessary, the motor function of the colon and pelvic floor muscles. The search for secondary causes should begin with the history and general examination. If no obvious etiology is found, special tests can be selected to diagnose functional constipation in a targeted manner. 2.Symptoms and signs: reduced frequency of defecation, hard stool, defecation difficulty and anal pain. Self-perceived abdominal distension and vague pain in the lower abdomen, bowel sounds and more exhaustion. Long-term constipation can be secondary to hemorrhoids or rectal prolapse. If the stool stays in the rectum for a long time, there may be a sensation of downward movement and incomplete defecation due to local inflammation. There may be loss of appetite, fatigue, dizziness, headache and other systemic symptoms. Long-term insufficient food intake, malnutrition can occur, further aggravating constipation. In severe constipation, there may be unconscious flow of intestinal secretion or unformed stool around the dry stool, soiling the underwear, which is similar to fecal incontinence, called “incontinence overflow”, and children may come to the clinic for frequent stools or even “diarrhea”. Routine physical examination usually has no positive physical findings. The abdomen may be distended and a fecal mass may be palpable in the left lower abdomen in the sigmoid colon, which disappears spontaneously after bowel cleansing. If the rectum is empty, the constipation is of colonic weakness type. Sometimes, after finger examination, a large amount of feces and gas is expelled with the dilatation of the anus, and the symptoms disappear, and organic intestinal obstruction can be excluded. Larger children can be asked to do the movement of defecation and can feel the relaxation of the external sphincter and the descent of the perineum, if not, it indicates the coordination disorder of the pelvic floor muscle groups. Pay attention to the presence of hemorrhoids, anal fissures, diaper rash around the anus, skin infections, etc. 3, laboratory tests: blood electrolytes, kidney function, thyroid function, blood sugar and urine sugar, barium enema angiography, rectal biopsy, lower gastrointestinal tract dynamics, anal canal rectal sensation and other tests to help clarify the cause of constipation and exclude organic diseases.