Pharmacological management of childhood constipation: Bridging today’s gaps with tomorrow’s therapies

Childhood constipation is a prevalent yet frequently underestimated global health concern, affecting approximately 10% of children across diverse populations. Its impact extends well beyond bowel-related symptoms, with affected children often experiencing extraintestinal manifestations such as pain in multiple sites, behavioral disturbances, and a markedly diminished quality of life. The burden is further compounded in low- and middle-income countries, where financial and logistical constraints limit access to effective treatment. The impact is intensified in developing countries due to limited healthcare resources and the unavailability of pharmacological agents. When left untreated or poorly managed, functional constipation (FC) can lead to significant long-term consequences, including persistent bowel dysfunction, psychological disorders, and progression to chronic constipation and other disorders of gut-brain interaction later in life. Pathophysiology of FC is multifactorial, involving factors such as stool withholding behavior, dietary habits, anorectal dysfunction, and psychological factors. Hence, management of FC is multifaceted, including both pharmacological and non-pharmacological interventions. Pharmacological management remains central to treatment, aimed at relieving symptoms and preventing adverse outcomes. However, current therapeutic strategies rely predominantly on a narrow range of osmotic and stimulant laxatives. Introducing new drugs that have often been shown to be effective in adults, have been found to have limited efficacy in children, with some performing no more effectively than a placebo in clinical trials. This highlights a substantial gap in pediatric pharmacotherapy and emphasizes the pressing need for new, evidence-based interventions tailored to the unique physiological and developmental characteristics of children. In this review, we critically examine the current pharmacologic options for managing childhood constipation, assess their limitations, and explore future directions of these drugs and other novel interventions for the development of more effective, accessible, and child-appropriate treatments for this common yet impactful condition.