1. Etiology

• mechanisms which increase colonic transit time:
  • enhanced colonic autonomic reaction to stress
  • innate abnormalities in the regulation of colonic fluid resorbing capacity, pressure generation, and motility thus:
    • preventing the final desiccation of feces
    • preventing colonic bacterial digestion of plant fibre
    • undigested vegetables in the stool

1. Prodrome

• no diarrhea (not a postenteritis syndrome)
• healthy, thriving child with no evidence of:
  • malabsorption or malnutrition
  • failure to thrive or weight loss
  • dehydration or electrolyte disturbances

2. Diarrhea

• 3 to 10 (usually <5) stool per day
• loose, brown, watery, non-foul smelling
• contain mucus, undigested vegetable fibres & starch granules
• contain no occult blood, leukocytes, eosinophils

3. Complications

• rectal fissures or perianal excoriations -> fecal blood

1. Reassurance

• a benign, self-limiting disorder
• natural history of recurrent episodes with spontaneous remissions
• may be an early manifestation of
  1. Irritable Bowel Syndrome
  2. Recurrent Abdominal Pain Syndrome

2. Diet

• nutritionally normal diet for age
• may restrict:
  • fruit juices
  • excessive water intake
  • cold foods
• do not restrict the intake of milk or milk products (i.e., fats)

3. Medications

• do not use antispasmodics or antidiarrheal agents
• may use:
  • methylcellulose as a stool-firmer & to decrease cramping
  • psyllium - 2 to 3 grams po bid for 2 weeks