Prevalence of functional constipation in Asian children and adolescents: a systematic review and meta-analysis of cross-sectional studies

Functional constipation (FC) is a common pediatric disorder, though synthesized prevalence data specific to Asian children remain limited. This meta-analysis aimed to estimate the pooled prevalence of FC among Asian children and adolescents and explore sources of heterogeneity. We conducted a systematic review following PRISMA guidelines and registered the protocol with PROSPERO (CRD420251274382). Cross-sectional studies using Rome III or Rome IV criteria and reporting FC prevalence in individuals aged 0–18 years were identified through comprehensive searches of MEDLINE (PubMed), Embase, Cochrane CENTRAL, LILACS, CNKI, and Ichushi‑Web from inception to December 30, 2025. Grey literature including conference proceedings, dissertations, and clinical trial registries was also screened. A random-effects meta-analysis of proportions was performed using logit-transformed prevalence rates. Heterogeneity was assessed using the I² statistic and Cochran’s Q test. Subgroup analyses were conducted by age group (0–6 vs. 7–18 years), geographic region (East, Southeast, and West Asia), study setting (hospital, community, school), and diagnostic criteria (Rome III vs. Rome IV). Sensitivity analysis and publication bias assessment were also performed. Seventeen studies involving 175,418 participants were included. The pooled prevalence of FC was 8% (95% CI: 5–11%; I² = 99.8%). The 95% prediction interval ranged from 1% to 25%, indicating wide variability across studies. Prevalence was numerically higher in adolescents (13%) than in young children (7%), in school-based settings (13%) compared to community settings (5%), and varied regionally from 6% in Southeast Asia to 10% in West Asia. Estimates were similar for studies using Rome III (10%) and Rome IV (10%) criteria. Leave-one-out sensitivity analysis confirmed the robustness of the pooled estimate. The pooled estimate of FC prevalence was 8% (95% CI: 5–11%). However, extreme statistical heterogeneity (I² = 99.8%) and a very wide prediction interval (1%–25%) indicate that this figure should not be interpreted as a precise or generalizable prevalence for Asian children and adolescents. Instead, the results highlight substantial methodological and contextual variability across studies, underscoring the need for cautious interpretation. Findings underscore the need for standardized diagnostic protocols, regionally tailored interventions, and high-quality, geographically diverse primary research.