In the treatment of pediatric patients with voiding dysfunction, the role of constipation is well established. Clearly the identification of patients with voiding dysfunction and coexistent bowel dysfunction is of paramount importance. Nevertheless, accurately determining the presence of functionally significant constipation by history or imaging remains a challenge. There are few assessment tools based on patient history (physician or patient/family reported) or imaging that provide a reliable, reproducible and objective assessment of constipation. This absence not only results in difficulty assessing functionally significant constipation in a clinical setting, but also creates confusion when attempting to compare studies addressing the issue. Among the methods of assessment available a concise, objective, history based evaluation is certainly ideal. While recent reports demonstrate the validity and usefulness of a bowel/bladder dysfunction (BBD) questionnaire in the initial assessment of constipation, there remains a dearth of literature demonstrating satisfactory inter-rater reliability (IRR) between assessments of constipation by the patient/family and provider, or an objective history based assessment of treatment outcome.
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