Modern Pediatrics. Ukraine. (2026).1(153): 103-118. doi: 10.15574/SP.2026.1(153).103118
Rybalchenko V. F.^1,2, Kozachuk V. G.^1,2, Rybalchenko I. G.³, Taranenko T. V.^1,2
1Shupyk National University of Healthcare of Ukraine, Kyiv
²KNP "Kyiv City Children's Clinical Hospital No. 1", Ukraine
³Private higher educational institution "Kyiv Medical University", Ukraine

For citation: Rybalchenko VF, Kozachuk VG, Rybalchenko IG, Taranenko TV. (2026). Clinical and diagnostic features of bowel emptying disorders in children, taking into account proctogenic pain against the background of acquired pathology of the anal canal and rectum and their treatment. Modern Pediatrics. Ukraine. 1(153): 103-118. doi: 10.15574/SP.2026.1(153).103118.
Article received: Dec 05, 2025. Accepted for publication: Feb 08, 2026.

Aim – is to investigate bowel emptying disorders in children with acquired pathology of the anal canal and rectum, taking into account proctogenic pain, and to substantiate approaches to their comprehensive diagnosis and treatment.
Material and methods. The study included 286 sick children who had bowel emptying disorders against the background of acquired pathology of the anorectal region, which was established during the examination: proctitis in 51 (17.83%), hemorrhoids in 125 (43.71%), anal fissure in 67 (23.43%) and cryptitis in 43 (15.03%). There were 141 boys (49.30%), girls 145 (50.70%).
Results. The studies have established clear age-related characteristics of the incidence with a peak in the group of 4-9 years (28.67%). It was established that bowel emptying disorders in children are manifested by the formation of pathological stereotypes of defecation, in particular, defecation in a diaper (17.48%), feces smearing (15.38%) and defecation in uncomfortable conditions (13.64%), which indicates a significant influence of proctogenic pain. It is proven that proctogenic pain is the leading clinical syndrome and is observed in 85.32% of patients, with intense pain during defecation prevailing (44.75%), and unbearable pain for anal fissure (18.88%) and hidden pain (21.69%). It was found that children develop a negative attitude towards the examination: pronounced negativity towards the examination was noted in 27.27% of cases, towards discussion of constipation – in 20.27%, and smearing – in 13.64%, while adequate perception of the situation is observed only in 17.83% of patients.
Conclusions. Violations of bowel emptying are accompanied by the formation of pathological behavioral stereotypes: emptying into a diaper (17.48%), smearing (15.38%) and defecation in uncomfortable conditions (13.64%). Proctogenic pain is the leading syndrome (85.32%), with a predominance of intense pain (44.75%) and unbearable pain with anal fissure (18.88%), and together with a negative attitude to the examination (27.27%) and discussion of problems (20.27%) forms a vicious circle of “pain – fear – avoidance of defecation – progression of pathology”, which determines the need for a comprehensive approach to treatment. Conservative treatment methods had good results in 98.95%, and surgical treatment was performed in 1.05% patients with hemorrhoids.
The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patients was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Keywords: children, constipation, proctitis, hemorrhoids, anal fissure, cryptitis, diagnosis, treatment, prevention.

REFERENCES

1. Akinmoladun O, Oh W. (2024, Jun). Management of Hemorrhoids and Anal Fissures. Surg Clin North Am. 104(3): 473-490. Epub 2023 Dec 9. https://doi.org/10.1016/j.suc.2023.11.001; PMid:38677814

2. Akkoyun I, Akbiyik F, Soylu SG. (2011, Nov). The use of digital photos and video images taken by a parent in the diagnosis of anal swelling and anal protrusions in children with normal physical examination. J Pediatr Surg. 46(11): 2132-2134. https://doi.org/10.1016/j.jpedsurg.2011.07.003; PMid:22075344

3. Allen P, Setya A, Lawrence VN. (2024, Jan 11). Pediatric Functional Constipation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. URL: https://www.ncbi.nlm.nih.gov/books/NBK537037/.

4. Alonso-Bermejo C, Barrio J, Fernández B, García-Ochoa E, Santos A et al. (2022, May) Functional gastrointestinal disorders frequency by Rome IV criteria. An Pediatr (Engl Ed). 96(5): 441-447. Epub 2022 May 6. https://doi.org/10.1016/j.anpede.2021.05.013; PMid:35534416

5. Aydoğdu S, Cakir M, Yüksekkaya HA, Arikan C, Tümgör G et al. (2009, Mar-Apr). Chronic constipation in Turkish children: clinical findings and applicability of classification criteria. Turk J Pediatr. 51(2): 146-153. PMID: 19480326.

6. Bashir SK, Khan MB. (2024). Pediatric Functional Constipation: A New Challenge. AGMR. 2024: Article ID 5569563. https://doi.org/10.1155/2024/5569563

7. Biletska OD. (2019). The psychological aspects of age crises of personality from birth to adolescence. Psychology: Reality and Perspectives. 11(2018): 36-42. https://doi.org/10.35619/prap_rv.vi11.6

8. Cenni S, Colucci A, Salomone S, Pacella D, Casertano M, Buono P et al. (2025, May). The prevalence of constipation in children with new diagnosis of inflammatory bowel disease: A retrospective study. J Pediatr Gastroenterol Nutr. 80(5): 799-806. Epub 2025 Feb 11. https://doi.org/10.1002/jpn3.70005; PMid:39935294

9. Combs AJ, Van Batavia JP, Chan J, Glassberg KI. (2013. Sep). Dysfunctional elimination syndromes – how closely linked are constipation and encopresis with specific lower urinary tract conditions? J Urol. 190(3): 1015-1020. Epub 2013 Mar 29. https://doi.org/10.1016/j.juro.2013.03.111; PMid:23545098

10. Dehghani SM, Kulouee N, Honar N, Imanieh MH, Haghighat M, Javaherizadeh H. (2015, Jan). Clinical Manifestations among Children with Chronic Functional Constipation. Middle East J Dig Dis. 7(1): 31-35. PMID: 25628851; PMCID: PMC4293798.

11. Docter D, van Braak H, de Jong B, Gorter RR, Benninga MA, de Jong JR. (2025, Aug 14). Pediatric external hemorrhoids: clinical characteristics and outcomes of conservative treatment versus injection sclerotherapy. Eur J Pediatr. 184(9): 552. https://doi.org/10.1007/s00431-025-06392-2; PMid:40813828 PMCid:PMC12354542

12. Doğan G, Keçeli M, Yavuz S, Topçu A, Kasırga E. (2022, Dec). Measurement of Rectal Diameter and Anterior Wall Thickness by Ultrasonography in Children with Chronic Constipation. Turk J Gastroenterol. 33(12): 1062-1068. https://doi.org/10.5152/tjg.2022.22165; PMid:36510402 PMCid:PMC9797706

13. Erkel D, Märzheuser S, Lindert J. (2024, Jul 19). Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study. Pediatr Surg Int. 40(1): 202. https://doi.org/10.1007/s00383-024-05771-4; PMid:39030300 PMCid:PMC11271418

14. Eslamian G, Jamee M, Momen T, Rohani P, Ebrahimi S, Mesdaghi M et al. (2024, Jun 20). Genomic testing identifies monogenic causes in patients with very early-onset inflammatory bowel disease: a multicenter survey in an Iranian cohort. Clin Exp Immunol. 217(1): 1-11. https://doi.org/10.1093/cei/uxae037; PMid:38651248 PMCid:PMC11188541

15. Fedele F, Fioretti MT, Scarpato E, Martinelli M, Strisciuglio C, Miele E. (2024, Apr 8). The ten "hard" questions in pediatric functional constipation. Ital J Pediatr. 50(1): 64. https://doi.org/10.1186/s13052-024-01623-y; PMid:38649896 PMCid:PMC11036569

16. Gardner IH, Siddharthan RV, Tsikitis VL. (2020). Benign anorectal disease: hemorrhoids, fissures, and fistulas. URL: http://www.annalsgastro.gr/index.php/annalsgastro/article/view/4765/4762. https://doi.org/10.20524/aog.2019.0438

17. Hamdy AM, Sakr HM, Boules IS, Awad YMM. (2023, Mar). The role of rectal ultrasound in children with functional constipation. J Paediatr Child Health. 59(3): 533-536. Epub 2023 Jan 30. https://doi.org/10.1111/jpc.16344; PMid:36718568

18. Harma B. (2023, Mar). Conservative management of anal fissure accompanying constipation in school-age children. Medicine Science. International Medical Journal. 12(1): 319-323. https://doi.org/10.5455/medscience.2023.01.04

19. Hyams DS, Di Lorenzo C, Saps M, Schulman RJ, Staiano A, van Tilburg M. (2016). Functional disorders: children and adolescents. Gastroenterology. 150(6): 1456-1468.e2,2016. https://doi.org/10.1053/j.gastro.2016.02.015; PMid:27144632 PMCid:PMC7104693

20. Imanzadeh F, Hosseini A, Khalili M, Naghdi E, Hajipour M, Yazdanifard P et al. (2022) Transabdominal Ultrasound Measurement of the Diameter of Rectal Ampulla as a Less Invasive Modality for Digital Rectal Examination in Children with Functional Constipation. Inn J Pediatr. 32 (5): e114354. https://doi.org/10.5812/ijp-114354

21. Jamshidi R. (2018, Mar). Anorectal Complaints: Hemorrhoids, Fissures, Abscesses, Fistulae. Clin Colon Rectal Surg. 31(2): 117-120. Epub 2018 Feb 25. https://doi.org/10.1055/s-0037-1609026; PMid:29487494 PMCid:PMC5825861

22. Kim K, Jeon HJ, Bae SH. (2020, Jan 30). Value of Fluoroscopic Defecography in Constipated Children With Abnormal Colon Transit Time Test Results. J Neurogastroenterol Motil. 26(1): 128-132. https://doi.org/10.5056/jnm18201; PMid:31715093 PMCid:PMC6955200

23. Kim YB, Kim JY, Choi S, Kim HJ, Lee YM, Lee Y et al. (2022, Mar 7). Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children Presenting With Isolated Hematochezia. Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children Presenting With Isolated Hematochezia. J Korean Med Sci. 37(9): e72. https://doi.org/10.3346/jkms.2022.37.e72; PMid:35257527 PMCid:PMC8901882

24. Konoplitskyi VS. (2015). Hostra analna trishchyna u ditei (ohliad literatury ta vlasni sposterezhennia). Khirurhiia dytiachoho viku. 3-4(48-49): 112-119.

25. Le Helloco C, Maruani A, Le Touze A, Herbreteau D, Leducq S. (2022, Apr 13). Lesion of the Anal Margin in a Young Child: A Quiz. Acta Derm Venereol. 102: adv00696. https://doi.org/10.2340/actadv.v102.1177; PMid:35166854 PMCid:PMC9558758

26. Leung AK, Hon KL. (2021, Mar 26). Paediatrics: how to manage functional constipation. Drugs Context. 10: 2020-11-2. https://doi.org/10.7573/dic.2020-11-2; PMid:33828605 PMCid:PMC8007206

27. Levy EI, Lemmens R, Vandenplas Y, Devreker T. (2017, Mar 9). Functional constipation in children: challenges and solutions. Pediatric Health Med Ther. 8: 19-27. https://doi.org/10.2147/PHMT.S110940; PMid:29388621 PMCid:PMC5774595

28. Lin M, Zhu H, Zhang R, Wang H. (2022, Sep). Causes of bloody stools in neonates: a case series report. Transl Pediatr. 11(9): 1438-1444. https://doi.org/10.21037/tp-22-166; PMid:36247883 PMCid:PMC9561507

29. Malik I, Sami A, Yousuf W, Tariq S, Jan S, Niyaz T. (2023, Jul). Etiological Profile of Lower Gastrointestinal Bleeding in Children and Adolescents from Kashmir; A Tale of 5 Years. Middle East J Dig Dis. 15(3): 180-184. Epub 2023 Jul 30. https://doi.org/10.34172/mejdd.2023.341; PMid:38023467 PMCid:PMC10660323

30. Meseeha M, Attia M. (2023, Aug 8). Proctitis and Anusitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. URL: https://www.ncbi.nlm.nih.gov/books/NBK430892/.

31. Momeni M, Momen-Gharibvand M, Kulouee N, Javaherizadeh H. (2019, May 20). Ultrasonography in determining the rectal diameter and rectal wall thickness in children with and without constipation: a case-control study. Arquivos de Gastroenterologia. 56(1): 84-87. https://doi.org/10.1590/s0004-2803.201900000-19; PMid:31141069

32. Mugie SM, Bates DG, Punati JB, Benninga MA, Di Lorenzo C, Mousa HM. (2015, Feb). The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children. Pediatr Radiol. 45(2): 173-180. Epub 2014 Sep 30. https://doi.org/10.1007/s00247-014-3137-3; PMid:25266954

33. Özdamar MY. (2018, Jan). Anal fissure epidemiology and related diseases in children. Southern Clinics of Istanbul Eurasia. 29(4). 295-300. https://doi.org/10.14744/scie.2018.84803

34. Pan Y, Jiao FY. (2025). Addressing functional constipation in children: A call for comprehensive and collaborative management. World J Gastroenterol. 31(7): 98889. https://doi.org/10.3748/wjg.v31.i7.98889

35. Patkova B, Wester T. (2020, Oct). Anal Fissure in Children. Eur J Pediatr Surg. 30(5): 391-394. Epub 2020 Sep 13. https://doi.org/10.1055/s-0040-1716723; PMid:32920798

36. Pop D, Tătar S, Fufezan O, Farcău D. (2021, Aug). Rectum sizes: Assessment by ultrasonography in children with functional constipation. J Paediatr Child Health. 57(8): 1244-1249. Epub 2021 Mar 4. https://doi.org/10.1111/jpc.15435; PMid:33665902

37. Quitadamo P, Isoldi S, Mallardo S, Zenzeri L, Ceccanti S, Battagliere I et al. (2024). Rectal Bleeding in Infants: Diagnostic Work-up and Management. Curr Pediatr Rev. 20(3): 286-295. https://doi.org/10.2174/1573396319666230210111048; PMid:36809947

38. Rybalchenko VF, Berezhnyi VV, Konoplytskyi VS, Rusak PS, Kozachuk VH, Pereiaslov AA ta insh. (2018). Porushennia vyporozhnen u ditei: Zakrepy ta enkoprez. Navchalnyi posibnyk. Kyiv: PP «INPOL LTM», TOV «Drukarnia Ruta»: 518.

39. Rybalchenko VF, Melnychenko MG, Kozachuk VG. (2024). Anal fissure in children – a pediatric or surgical problem? The Odessa Medical Journal. 6(191): 39-44. https://doi.org/10.32782/2226-2008-2024-6-7

40. Sanchez-Avila MT, Garcia-Valencia OA, Rivas-Calderon M, Morales-Garza LA, Jacobo-Velazquez P, Chavez-Caraza KL. (2018). Frequency and findings of the acquired anorectal disease in the pediatric population with chronic constipation. Turk J Pediatr. 60(5): 547-553. https://doi.org/10.24953/turkjped.2018.05.012; PMid:30968637

41. Scott SM, van den Berg MM, Benninga MA. (2011) Rectal sensorimotor dysfunction in constipa-tion. Best Pract Res Clin Gastroenterol. 25: 103-118. https://doi.org/10.1016/j.bpg.2011.01.001; PMid:21382582

42. Sissoko NDN, Chen W, Wang C, Wu Y, Zheng X, Dong X et al. (2023, May 1). Associations between functional constipation and non-IgE-mediated food allergy in infants and children. Allergol Immunopathol (Madr). 51(3): 163-173. https://doi.org/10.15586/aei.v51i3.738; PMid:37169574

43. Sunkari K, Siddiqui MS, Mishrikotkar PS, Engade MB, Totla RJ, Joshi PM et al. (2025, Jul 1). Transabdominal Ultrasound Measured Rectal Diameter for Identifying Fecal Impaction in Children With Functional Constipation: A Diagnostic Accuracy Study. Cureus. 17(7): e87100. PMID: 40747168; PMCID: PMC12312619. https://doi.org/10.7759/cureus.87100

44. Tran DL, Nguyen Trong Tran P, Susantitaphong P, Phinyo P, Sintusek P. (2025, Feb). Value of transabdominal ultrasonography for diagnosing functional constipation in children: a systematic review and meta-analysis. Clin Exp Pediatr. 68(2): 127-135. Epub 2024 Nov 13. https://doi.org/10.3345/cep.2024.00927; PMid:39533722 PMCid:PMC11825114

45. Tran DL, Sintusek P. (2023, Feb 28). Functional constipation in children: What physicians should know. World J Gastroenterol. 29(8): 1261-1288. https://doi.org/10.3748/wjg.v29.i8.1261; PMid:36925458 PMCid:PMC10011959

46. Vinmec healthcare system. (2025, Jan 25). Auses of anal pain and itching in children. URL: https://www.vinmec.com/eng/blog/causes-of-pain-and-itching-in-the-anus-en

47. Vos JMBW, Bloem MN, de Geus A, Leeflang MMG, Spijker R, Koppen IJN et al. (2024, Dec). Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal impaction in children: a systematic review and meta-analysis. Pediatr Radiol. 54(13): 2227-2242. Epub 2024 Nov 15. https://doi.org/10.1007/s00247-024-06083-4; PMid:39545958 PMCid:PMC11638420

48. Yu M, Shang Y, Han L, Yu X. (2024, May 10). Bowel Habits, Obesity, Intestinal Microbiota and Their Influence on Hemorrhoidal Disease: a Mendelian Randomization Study. Clin Exp Gastroenterol. 17: 157-164. https://doi.org/10.2147/CEG.S450807; PMid:38745764 PMCid:PMC11093121

49. Zhang SC, Wang WL, Liu X. (2014) Defecography used as a screening entry for identifying evacuatory pelvic floor disorders in childhood constipation. Clin Imaging. 38: 115-121. https://doi.org/10.1016/j.clinimag.2013.11.010; PMid:24411487