Tethered cord syndrome (TCS) and constipation in children: a multifaceted approach (literature review).

Tethered cord syndrome (TCS) is estimated to affect approximately 25 per 100 000 live births. Despite advancements in medical knowledge and technology, the persistence of this issue is attributed to challenges in early detection and limited awareness, often resulting in undiagnosed cases until adulthood. Constipation serves as a noteworthy symptom in children with TCS, yet it frequently goes unnoticed or is ascribed to other causes, leading to delayed diagnosis and negatively impacting a child's quality of life. The aim of this manuscript is to explore the relationship between TCS and constipation in children, focusing on the prevalence, clinical manifestations, diagnostic challenges, and existing treatment methods by synthesizing information from relevant literature. Ultimately, the goal is to shed light on the multifaceted aspects of TCS and its connection to constipation, emphasizing the need for a comprehensive, multidisciplinary approach to effectively manage this condition in children. Notably, nerve dysfunction that affects bowel motions is often the cause of constipation in children with TCS. A multimodal strategy that includes pharmaceutical treatments, dietary changes, and novel techniques, like neuromodulation and biofeedback therapy, is required for effective management. Given its safety and tolerance in children, key findings emphasize the effectiveness of osmotic laxatives, especially polyethylene glycol (PEG), as a first-line treatment for chronic constipation. Physical therapies, such as pelvic floor physiotherapy and biofeedback, show promise in enhancing rectal sensation and bowel coordination. Bowel function is typically improved with neurosurgical intervention to reduce spinal cord tethering, although there are risks, including re-tethering. Minimally invasive surgical techniques are promising, but more research is needed. Social and intellectual developments are negatively impacted by psychological effects, which are common and include anxiety and depression associated with chronic gastrointestinal problems. In conclusion, addressing constipation in children with TCS necessitates a multimodal strategy and collaborative efforts across different disciplines for optimal management.