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Benson K, Bazier A, Schwartzkopf K, Waseem S, Gilbert E. Psychosocial factors impacting antegrade continence enema outcomes in pediatric patients. Neurogastroenterol Motil 2023; 35:e14644. [PMID: 37427680 DOI: 10.1111/nmo.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Children with constipation and encopresis are often treated with medication and behavioral approaches. When constipation persists, surgical interventions such as antegrade continence enema (ACE) procedures are considered. Many children benefit from these procedures; however, some children continue to have incontinence, experience complications, or discontinue the use of the ACE stoma. There is some evidence in the literature to indicate that psychosocial factors can have an impact on ACE outcomes; however, standardized biopsychosocial guidelines related to ACE candidacy and surgery do not currently exist. PURPOSE The purpose of this review is to summarize the research to date on psychosocial factors related to ACE treatment outcomes and complications. Identifying what is known and what limitations remain can support future research to inform development of guidelines for pre-procedure evaluations. Psychosocial pre-procedure evaluations could help to inform eligibility for the procedure as well as interventions to enhance outcomes for children at increased risk for poor outcomes or complications from ACE. Age, psychiatric symptoms, and adherence to the ACE flush regimen were some of the factors identified in the literature as impacting ACE outcomes; however, there is limited research in this area.
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Affiliation(s)
- Kari Benson
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ashley Bazier
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Shamaila Waseem
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elaine Gilbert
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Finch EF, Shikatani B, Snir A, Smith L. Treating Volitional Elimination Disorders in a Healthy Adult: Applying Cognitive Behavioral Principles in the Absence of Treatment Guidelines. Clin Case Stud 2022. [DOI: 10.1177/15346501221107133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elimination disorders are common in children, and numerous psychosocial treatments for pediatric enuresis and encopresis are available to guide clinicians. However, only five cases of functional elimination disorders in adults are published to date, all of which involve severe comorbid psychopathology, and no treatment guidelines for adult elimination disorders exist. This case report presents, to our knowledge, the first documented case of functional elimination disorder in an otherwise healthy, high-functioning adult. “Ben” is a 20-year-old male who sought treatment for chronic enuresis and encopresis, as well as difficulties with procrastination of schoolwork. Ben engaged in 21 weeks of cognitive behavioral therapy and reported substantial decreases in elimination disorder symptoms. However, improvements fluctuated throughout treatment and remained present at mild levels at 3-month follow-up. This report outlines the cognitive behavioral interventions applied throughout this treatment, which consisted of pediatric elimination disorder interventions adapted for an adult with additional cognitive behavioral tools.
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Affiliation(s)
| | | | - Avigal Snir
- Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
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Group Treatment of Fecal Incontinence: A Description of an Interdisciplinary Intervention. J Pediatr Gastroenterol Nutr 2019; 69:e70-e74. [PMID: 31058779 DOI: 10.1097/mpg.0000000000002372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20% to 60% of cases. A combined medical-behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group-based treatment for fecal incontinence in school-aged children, and to present a description of changes in treatment adherence rates that affect clinical effectiveness. METHOD Poop group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6-week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre- to post-treatment. Group sessions focus on the GI system, medication, toilet sitting posture, hydration, fiber, and behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed. RESULTS Nineteen families completed the 6-week protocol. Appropriate stool frequency was improved (P ≤ 0.01), and soiling was reduced (P ≤ 0.00). Medication adherence was also improved (P ≤ 0.04). Treatment results were maintained at 1-month follow-up. DISCUSSION A developmentally targeted intervention and interdisciplinary focus of treatment likely account for treatment successes. CONCLUSION Poop group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment.
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Morgan KE, Leroy SV, Corbett ST, Shepard JA. Complementary and Integrative Management of Pediatric Lower Urinary Tract Dysfunction Implemented within an Interprofessional Clinic. CHILDREN (BASEL, SWITZERLAND) 2019; 6:children6080088. [PMID: 31366055 PMCID: PMC6721344 DOI: 10.3390/children6080088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Abstract
Lower urinary tract dysfunction in children is a common multifactorial functional problem that often correlates with bowel dysfunction and behavioral disorders. Ideal management combines integrative therapies that optimize bladder and bowel habits, address behavioral issues, foster mind–body connection, and improve pelvic floor muscle dysfunction. Movement therapies that teach diaphragmatic breathing and relaxation, mind–body awareness, and healthy pelvic floor muscle function are vital for long-term symptom improvement in children. This paper outlines recommendations for integrative management of these patients and discusses a recently developed interprofessional clinic that aims to better meet these patients’ complex needs and to provide patients with an integrated holistic plan of care. Additional work is needed to scientifically assess these treatment models and educate providers across the various disciplines that evaluate and treat these patients.
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Affiliation(s)
- Kathryn E Morgan
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA.
| | - Susan V Leroy
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA
| | - Sean T Corbett
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA
| | - Jaclyn A Shepard
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, P.O. Box 800223, Charlottesville, VA 22908, USA
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Abstract
Paul is an 8-year-old boy with a long-standing history of encopresis and enuresis. Potty training was initiated when he was 2 years old. At this time, his mother was absent from the home for 6 weeks when she cared for her ill father in a different city. The process of teaching Paul to use the bathroom was described as "inconsistent" due to multiple caretakers.Paul never successfully mastered bowel and bladder control. He continues to wet and soil his clothes on a daily basis at home and school. According to his parents, he does not accept responsibility and comments about his soiling such as, "I didn't do it; someone else must have put it there." One of Paul's teachers commented that she could tell at the beginning of the school day whether he would maintain bowel and bladder control. If he was "agitated and talkative" in the early morning, he would often soil that day.He had a pediatric gastroenterological evaluation at the age of 5 years when he was having daily episodes of stool soiling. Physical examination revealed normal anal tone, normal placement of the anus, and moderate stool in the rectal vault. An abdominal radiograph revealed moderate stool throughout the colon. He was treated with Miralax and instructed to sit on the toilet twice daily. Paul did not respond to these interventions and was diagnosed with "overflow incontinence secondary to stool withholding." When he was taking Miralax, he had a normal barium enema radiograph. He was admitted to the hospital for a cleanout with a polyethylene glycol/electrolyte solution.Although abdominal radiographs demonstrated absence of colonic stool for the following 5 months, he continued to soil his clothing. Play therapy and biofeedback did not change the chronic soiling and wetting pattern. An evaluation at the Continence Clinic resulted in a rigorous program including stooling after each meal, wearing a vibrating watch reminding him to void every 2 hours, drinking 60 ounces of water per day, tracking elimination patterns on a calendar, and a daily laxative (polyethylene glycol). A neuropsychological evaluation revealed a superior aptitude associated with unresolved early childhood issues of self-control, self-care, and frustration tolerance. Family therapy was initiated. However, daily fecal soiling and wetting persisted.Paul was born full-term without prenatal or perinatal complications. He was breast fed for 1 year and described as an easy baby. He achieved motor, social, and language milestone on time. Paul had difficulty with separation and aggression in preschool (e.g., biting). In school, teachers report inattention, fidgetiness, and difficulty following directions. He has been obese since age 3 years; his current body mass index is 29.
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Shepard JA, Poler JE, Grabman JH. Evidence-Based Psychosocial Treatments for Pediatric Elimination Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:767-797. [PMID: 27911597 DOI: 10.1080/15374416.2016.1247356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pediatric elimination disorders are common in childhood, yet psychosocial correlates are generally unclear. Given the physiological concomitants of both enuresis and encopresis, and the fact that many children with elimination disorders are initially brought to their primary care physician for treatment, medical evaluation and management are crucial and may serve as the first-line treatment approach. Scientific investigation on psychological and behavioral interventions has progressed over the past couple of decades, resulting in the identification of effective treatments for enuresis and encopresis. However, the body of literature has inherent challenges, particularly given the multicomponent nature of many of the treatment packages. This review identified 25 intervention studies-18 for nocturnal enuresis and 7 for encopresis-over the past 15 years and classified them according to the guidelines set forth by the Task Force on the Promotion and Dissemination of Psychological Procedures. For nocturnal enuresis, the urine alarm and dry-bed training were identified as well-established treatments, Full Spectrum Home Therapy was probably efficacious, lifting was possibly efficacious, and hypnotherapy and retention control training were classified as treatments of questionable efficacy. For encopresis, only two probably efficacious treatments were identified: biofeedback and enhanced toilet training (ETT). Best practice recommendations and suggestions for future research are provided to address existing limitations, including heterogeneity and the multicomponent nature of many of the interventions for pediatric elimination disorders.
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Affiliation(s)
- Jaclyn A Shepard
- a Department of Psychiatry & Neurobehavioral Sciences , University of Virginia School of Medicine
| | - Joseph E Poler
- a Department of Psychiatry & Neurobehavioral Sciences , University of Virginia School of Medicine
| | - Jesse H Grabman
- a Department of Psychiatry & Neurobehavioral Sciences , University of Virginia School of Medicine
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Reed-Knight B, Claar RL, Schurman JV, van Tilburg MAL. Implementing psychological therapies for functional GI disorders in children and adults. Expert Rev Gastroenterol Hepatol 2016; 10:981-4. [PMID: 27356273 DOI: 10.1080/17474124.2016.1207524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Functional GI disorders (FGIDs) are common in adults and children. Psychological factors play an important role in the onset and maintenance of FGIDs and in explaining the associated disability. Psychological treatments such as Cognitive Behavioral Therapy and Hypnotherapy have been found efficacious in FGIDs but Integrating psychological treatments into traditionally medically-oriented care can be challenging. AREAS COVERED This review outlines the case for integrating psychological therapies into medical care for FGIDs and examine various models of integrated care that can be adapted to fit specific practice scenarios. Expert commentary: We advise integrating a psychologist in the care and treatment planning of every patient. Clinic-specific needs dictate how integrated care for patients with FGIDs can be delivered.
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Affiliation(s)
- Bonney Reed-Knight
- a Children's Healthcare of Atlanta , Department of Pediatrics Emory University School of Medicine, and GI Care for Kids , Atlanta , GA , USA
| | - Robyn Lewis Claar
- b Department of Medicine , University of North Carolina, Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders , Chapel Hill , NC , USA
| | | | - Miranda A L van Tilburg
- b Department of Medicine , University of North Carolina, Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders , Chapel Hill , NC , USA
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Need for Rectal Biopsy for Childhood Constipation Predicts Severity of Illness and Need for Laxatives. J Pediatr Gastroenterol Nutr 2016; 62:834-9. [PMID: 26551318 DOI: 10.1097/mpg.0000000000001033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study aimed to examine the long-term clinical outcomes of children with severe constipation, as defined by need for rectal biopsy (RB), and to determine which baseline characteristics were predictors of successful outcome. METHODS Children with severe constipation who underwent RB for evaluation of Hirschsprung disease at a tertiary medical center were eligible. A cohort of children with constipation without a history of RB served as controls (matched 2:1 by sex and age). Retrospective chart review of clinic visits was performed at baseline, 3, 6, 12, 18, and 24 months. Successful clinical outcomes were defined as ≥3 bowel movements weekly for ≥4 weeks, with ≤2 fecal incontinence episodes monthly, irrespective of laxative use. RESULTS A total of 175 RB children (90 boys, mean age: 6.7 years) were matched to 350 controls. Mean duration of constipation symptoms before intake in the RB group was significantly longer compared with controls (3.7 vs 0.4 years, P < 0.001). By 24 months, the cumulative percentage of children achieving at least 1 period of successful outcome was significantly higher in the control group compared with RB population (73% vs 24%, P < 0.001). Multivariate analysis revealed that younger age (P = 0.001, odds ratio 0.87) and shorter duration of constipation before RB (P = 0.03, odds ratio 0.45) were significant predictors of successful outcome. CONCLUSIONS Only one-quarter of patients with severe constipation achieved successful outcome during 2-year follow-up. Younger age and shorter duration of constipation at time of biopsy were predictors of successful outcomes, emphasizing the importance of early diagnosis and initiation of treatment in this population.
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Hill SR, Ehrlich PF, Felt B, Dore-Stites D, Erickson K, Teitelbaum DH. Rectal prolapse in older children associated with behavioral and psychiatric disorders. Pediatr Surg Int 2015; 31:719-24. [PMID: 26163086 DOI: 10.1007/s00383-015-3733-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Rectal prolapse (RP) beyond infancy is challenging, and despite surgical correction, recurrences are not uncommon, suggesting that underlying contributing processes may have a role. This study highlights a previously poorly recognized relationship between RP in older children and behavioral/psychiatric disorders (BPD). We describe the incidence of recurrence and use of behavioral, psychological and physical therapeutic tactics in a multidisciplinary approach to pediatric RP. METHODS A retrospective 20-year review of RP in children >3 years of age was adopted. Charts were reviewed for gastrointestinal, connective tissue, and BPD conditions, incidence of recurrence, and therapies employed including surgery, behavioral, and physical therapy. RESULTS 45 patients were included, ranging from 3 to 18 years of age; 29 males. Thirty-seven underwent surgery. Six of the 45 were excluded as they had gastrointestinal or connective tissue conditions placing them at risk for prolapse. Over half (21/39, 53%) had BPD. Slightly more than half of patients had a recurrence, but there was no increased risk in those with associated BPD. While all 21 underwent some therapy for their BPD, over the past 5 years we have enrolled eight of these patients into a program of behavioral and/or physical therapy with all reporting reductions in frequency and severity of prolapse after initiating pelvic floor strengthening, behavior modification, and biofeedback, and avoidance of surgery in three. CONCLUSIONS This study highlights an important group of pediatric patients with RP that may well benefit from a combination of behavioral therapy, physical therapy as well as surgical intervention to obtain the most optimal outcome.
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Affiliation(s)
- Shelley Reynolds Hill
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI, 48109-4211, USA
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Freeman KA, Riley A, Duke DC, Fu R. Systematic Review and Meta-Analysis of Behavioral Interventions for Fecal Incontinence With Constipation. J Pediatr Psychol 2014; 39:887-902. [DOI: 10.1093/jpepsy/jsu039] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Steffan JJ, Dykes SS, Coleman DT, Adams LK, Rogers D, Carroll JL, Williams BJ, Cardelli JA. Supporting a role for the GTPase Rab7 in prostate cancer progression. PLoS One 2014; 9:e87882. [PMID: 24505328 PMCID: PMC3914878 DOI: 10.1371/journal.pone.0087882] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
Invasion and subsequent metastasis is the major cause of death from most cancers including prostate cancer. Herein we report on the potential tumor suppressive properties of Rab7, a GTPase that regulates trafficking of lysosomes. The movement of lysosomes to the cell surface in response to environmental cues increases the secretion of proteinases and cell invasion. We determined that Troglitazone and other members of the Thiazolidinedione family inhibit cell-surface directed lysosome trafficking and cathepsin B secretion through a Rab7-dependent mechanism. Moreover, Rab7 shRNA expressing cells were found to be more invasive in vitro and in vivo. Increased invasiveness was accompanied by elevated expression of the c-Met receptor and prolonged downstream signaling, thereby supporting a role for Rab7 as a mediator of signaling down-regulation. Taken together, these results suggested that Rab7 acts as a negative regulator of prostate tumor growth and invasion, providing further evidence for its potential as a tumor suppressor.
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Affiliation(s)
- Joshua J. Steffan
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Natural Science, Dickinson State University, Dickinson, North Dakota, United States of America
| | - Samantha S. Dykes
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - David T. Coleman
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Lisa K. Adams
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Donna Rogers
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Jennifer L. Carroll
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - B. Jill Williams
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Urology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - James A. Cardelli
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- * E-mail:
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Ritterband LM, Thorndike FP, Lord HR, Borowitz S, Walker LS, Ingersoll KS, Sutphen J, Cox DJ. An RCT of an Internet Intervention for Pediatric Encopresis with One Year Follow-Up. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2013; 1:68-80. [PMID: 24040581 DOI: 10.1037/cpp0000007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Boles RE, Roberts MC, Vernberg EM. Treating non-retentive encopresis with rewarded scheduled toilet visits. Behav Anal Pract 2012; 1:68-72. [PMID: 22477690 DOI: 10.1007/bf03391730] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We evaluated the effects of rewarded scheduled toilet sits on non-retentive encopretic behavior of an elementary-school student receiving services for serious emotional disturbance. A multidisciplinary team implemented the 8-week intervention using a multiple baseline across settings design. The results showed an increase in sitting on the toilet and a decline in encopretic episodes in both school and home settings. These findings support the use of a behavioral intervention for children with significant behavioral disorders within a classroom setting.
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Rozensky RH, Janicke DM. Commentary: Healthcare reform and psychology's workforce: preparing for the future of pediatric psychology. J Pediatr Psychol 2012; 37:359-68. [PMID: 22262914 DOI: 10.1093/jpepsy/jsr111] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ronald H Rozensky
- Department of Clinical and Health Psychology, College of Public Health and Health University of Florida, Gainesville, FL 32610, USA.
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Abstract
Paul is an 8-year-old boy with a long-standing history of encopresis and enuresis. Potty training was initiated when he was 2(1/2) years old. At this time, his mother was absent from the home for 6 weeks when she cared for her ill father in a different city. The process of teaching Paul to use the bathroom was described as "inconsistent" due to multiple caretakers.Paul never successfully mastered bowel and bladder control. He continues to wet and soil his clothes on a daily basis at home and school. According to his parents, he does not accept responsibility and comments about his soiling such as, "I didn't do it; someone else must have put it there." One of Paul's teachers commented that she could tell at the beginning of the school day whether he would maintain bowel and bladder control. If he was "agitated and talkative" in the early morning, he would often soil that day.He had a pediatric gastroenterological evaluation at the age of 5 years when he was having daily episodes of stool soiling. Physical examination revealed normal anal tone, normal placement of the anus, and moderate stool in the rectal vault. An abdominal radiograph revealed moderate stool throughout the colon. He was treated with Miralax and instructed to sit on the toilet twice daily. Paul did not respond to these interventions and was diagnosed with "overflow incontinence secondary to stool withholding." When he was taking Miralax, he had a normal barium enema radiograph. He was admitted to the hospital for a clean out with a polyethylene glycol/electrolyte solution. Although abdominal radiographs demonstrated absence of colonic stool for the following 5 months, he continued to soil his clothing. Play therapy and biofeedback did not change the chronic soiling and wetting pattern. An evaluation at the Continence Clinic resulted in a rigorous program including stooling after each meal, wearing a vibrating watch reminding him to void every 2 hours, drinking 60 ounces of water per day, tracking elimination patterns on a calendar, and a daily laxative (polyethylene glycol). A neuropsychological evaluation revealed a superior aptitude associated with unresolved early childhood issues of self-control, self-care, and frustration tolerance. Family therapy was initiated. However, daily fecal soiling and wetting persisted.Paul was born full-term without prenatal or perinatal complications. He was breast fed for 1 year and described as an easy baby. He achieved motor, social, and language milestone on time. Paul had difficulty with separation and aggression in preschool (e.g., biting). In school, teachers report inattention, fidgetiness, and difficulty following directions. He has been obese since age 3 years; his current body mass index is 29.
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Kuhl ES, Hoodin F, Rice J, Felt BT, Rausch JR, Patton SR. Increasing daily water intake and fluid adherence in children receiving treatment for retentive encopresis. J Pediatr Psychol 2010; 35:1144-51. [PMID: 20439348 DOI: 10.1093/jpepsy/jsq033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine the efficacy of an enhanced intervention (EI) compared to standard care (SC) in increasing daily water intake and fluid goal adherence in children seeking treatment for retentive encopresis. METHODS Changes in beverage intake patterns and fluid adherence were examined by comparing 7-week diet diary data collected during participation in the EI to achieved data for families who had previously completed the SC. RESULTS Compared to children in SC (n = 19), children in the EI (n = 18) demonstrated a significantly greater increase in daily water intake from baseline to the conclusion of treatment ( p ≤ .001), and were four and six times more likely to meet fluid targets in Phases 1 (Weeks 3-4) and 2 (Weeks 5-6) of fluid intervention, respectively (both p ≤ .001). CONCLUSIONS Enhanced education and behavioral strategies were efficacious in increasing children's intake of water and improving fluid adherence. Future research should replicate the findings in a prospective randomized clinical trial to discern their effectiveness.
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van Dijk M, Benninga MA, Grootenhuis MA, Last BF. Prevalence and associated clinical characteristics of behavior problems in constipated children. Pediatrics 2010; 125:e309-17. [PMID: 20083527 DOI: 10.1542/peds.2008-3055] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Behavior problems are common in children with functional constipation. This study assessed the prevalence of overall, internalizing, and externalizing behavior problems in children with functional constipation and explored which clinical characteristics of constipation are associated with these behavior problems. METHODS Children who had functional constipation, were aged 4 to 18 years, and were referred to the gastrointestinal outpatient clinic at the Emma Children's Hospital were eligible for enrollment. This study made use of baseline data of 133 children who participated in a randomized, controlled trial that evaluated the clinical effectiveness of behavioral therapy compared with conventional treatment. Prevalence of behavior problems was assessed by the Child Behavior Checklist. Univariate and multivariate logistic regression models were used to test the association between clinical characteristics and behavior problems. RESULTS The prevalence rate of overall, internalizing, and externalizing behavior problems was considerable: respectively 36.8%, 36.1%, and 27.1% compared with 9% in the Dutch norm population. A long duration of treatment was found to have the strongest association with overall and externalizing behavior problems in children with constipation. Children with constipation and nighttime urinary incontinence have an increased risk for having overall behavior problems. Fecal incontinence and the production of large stools seemed to be exclusively related to externalizing behavior problems. CONCLUSIONS Behavior problems are common in children who have constipation and are referred to gastrointestinal outpatient clinics, suggesting that a behavioral screening should be incorporated into the diagnostic workup of children with constipation.
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Affiliation(s)
- Marieke van Dijk
- MSc, Emma Children's Hospital, Academic Medical Center, Psychosocial Department, Room G8-224, PO Box 22700, 1100 DE Amsterdam, Netherlands.
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Hardy LT. Encopresis: a guide for psychiatric nurses. Arch Psychiatr Nurs 2009; 23:351-8. [PMID: 19766926 DOI: 10.1016/j.apnu.2008.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 09/04/2008] [Accepted: 09/08/2008] [Indexed: 01/15/2023]
Abstract
Encopresis is an elimination disorder that involves symptoms of fecal incontinence in children. It affects an estimated 1.5% to 7.5% of children ages 6 to 12 and accounts for approximately 3% to 6% of psychiatric referrals. The etiology of encopresis is thought to be related to physiologic problems such as constipation; however, it is also a psychiatric diagnosis and anecdotally may have some association with psychiatric problems. Publications on this association and publications directed toward psychiatric nurses are limited. Encopresis is typically treated with nutritional and medical management along with behavioral modification. Psychiatric nurses working with patients who have encopresis in inpatient settings will have unique concerns and challenges. This article gives an overview of published literature from the past 10 years on the etiology and treatment of encopresis. Specific suggestions for inpatient psychiatric nurses based on published literature and the author's professional experience are provided.
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Affiliation(s)
- Lyons T Hardy
- Virginia Treatment Center for Children, Virginia Commonwealth University Health System, Richmond, VA, USA.
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Limited evidence supports use of laxatives for functional constipation in children. J Pediatr 2009; 155:450-1. [PMID: 19732593 DOI: 10.1016/j.jpeds.2009.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kuhl ES, Felt BT, Patton SR. Brief report: Adherence to fluid recommendations in children receiving treatment for retentive encopresis. J Pediatr Psychol 2009; 34:1165-9. [PMID: 19304779 DOI: 10.1093/jpepsy/jsp017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Limited data are available regarding whether children being treated for retentive encopresis are adherent to recommendations to increase their daily fluid intake. The purpose of this study was to examine fluid adherence in children who received treatment for retentive encopresis. METHODS A retrospective chart review was performed using diet diary data for 26 children (ages 3-12) who completed a group behavioral intervention for retentive encopresis. RESULTS Mean daily intake of clear fluid increased significantly during treatment and children relied primarily on water and juice to make this dietary change. However, adherence rates to clear fluid goals were <50%. CONCLUSIONS Children's increased clear fluid intake did not equate to high fluid adherence. Children's high juice consumption is concerning as it could place them at risk for other negative health consequences. Future research should examine whether enhanced fluid education and use of behavior change strategies yield higher fluid adherence.
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Abstract
This article reports the clinical, physiopathologic, diagnostic, and therapeutic aspects of the most common anorectal disorders in children. In particular, it focuses on the differential diagnosis between organic and functional constipation. In addition, the authors separately examine some of the clinical conditions such as atopy, neurologic diseases, and anorectal malformations, in which chronic constipation may be an important clinical manifestation.
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van Dijk M, Bongers MEJ, de Vries GJ, Grootenhuis MA, Last BF, Benninga MA. Behavioral therapy for childhood constipation: a randomized, controlled trial. Pediatrics 2008; 121:e1334-41. [PMID: 18450876 DOI: 10.1542/peds.2007-2402] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE It has been suggested that the addition of behavioral interventions to laxative therapy improves continence in children with functional fecal incontinence associated with constipation. Our aim was to evaluate the clinical effectiveness of behavioral therapy with laxatives compared with conventional treatment in treating functional constipation in childhood. PATIENTS AND METHODS In this randomized, controlled trial conducted in a tertiary hospital in The Netherlands, 134 children aged 4 to 18 years with functional constipation were randomly assigned to 22 weeks (12 visits) of either behavioral therapy or conventional treatment. Primary outcomes were defecation frequency, fecal incontinence frequency, and success rate. Success was defined as defecation frequency of > or = 3 times per week and fecal incontinence frequency of < or = 1 times per 2 weeks irrespective of laxative use. Secondary outcomes were stool-withholding behavior and behavior problems. Outcomes were evaluated at the end of treatment and at 6-months follow-up. All of the analyses were done by intention to treat. RESULTS Defecation frequency was significantly higher for conventional treatment. Fecal incontinence frequency showed no difference between treatments. After 22 weeks, success rates did not differ between conventional treatment and behavioral therapy (respectively, 62.3% and 51.5%), nor did it differ at 6 months of follow-up (respectively, 57.3% and 42.3%). The proportion of children withholding stools was not different between interventions. At follow-up, the proportion of children with behavior problems was significantly smaller for behavioral therapy (11.7% vs 29.2%). CONCLUSION Behavioral therapy with laxatives has no advantage over conventional treatment in treating childhood constipation. However, when behavior problems are present, behavioral therapy or referral to mental health services should be considered.
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Affiliation(s)
- Marieke van Dijk
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Room G8-224, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
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Axelrad ME, Pendley JS, Miller DL, Tynan WD. Implementation of Effective Treatments of Preschool Behavior Problems in a Clinic Setting. J Clin Psychol Med Settings 2008; 15:120-6. [DOI: 10.1007/s10880-008-9110-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Constipation and encopresis (fecal soiling) are common childhood disorders that may lead to significant functional impairment. The etiology and course of constipation and encopresis are increasingly conceptualized from a broad biopsychosocial perspective, and therefore a holistic approach to assessment and treatment is indicated. Many children experience symptoms of chronic constipation and/or encopresis that are only partially responsive to conventional medical therapy. Complementary/alternative therapies can often help in the treatment of constipation/encopresis and are well accepted by patients and families.
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Affiliation(s)
- Timothy P Culbert
- Integrative Medicine Program, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404, USA.
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van Dijk M, Benninga MA, Grootenhuis MA, Nieuwenhuizen AMOV, Last BF. Chronic childhood constipation: a review of the literature and the introduction of a protocolized behavioral intervention program. PATIENT EDUCATION AND COUNSELING 2007; 67:63-77. [PMID: 17374472 DOI: 10.1016/j.pec.2007.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 02/05/2007] [Accepted: 02/06/2007] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To release a newly protocolized behavioral intervention program for children with chronic constipation aged 4-18 years with guidance from literature about underlying theories from which the treatment techniques follow. METHODS Articles until July 2006 were identified through electronic searches in Medline, PsychInfo and Picarta. There was no limit placed on the time periods searched. Following keywords were used: constipation, encopresis, fecal incontinence, psychotherapy, emotions, randomized controlled trials, parent-child relations, parents, family, psychology, behavioral, behavioral problems, psychopathology, toilet, social, psychosocial, pain, retentive posturing, stool withholding, stool toileting refusal, shame, stress, anxiety. A filter was used to select literature referring to children 0-18 years old. Key constructs and content of sessions for a protocolized behavioral intervention program are derived from literature. RESULTS Seventy-one articles on chronic childhood constipation are critically reviewed and categorized into sections on epidemiology, symptomatology, etiology and consequences, treatment and effectivity, and follow-up on chronic childhood constipation. This is followed by an extensive description of our protocolized behavioral intervention program. CONCLUSION This is the first article on childhood constipation presenting a full and transparent description of a behavioral intervention program embedded in literature. In addition, a theoretical framework is provided that can serve as a trial paradigm to evaluate intervention effectiveness. PRACTICE IMPLICATIONS This article can serve as an extensive guideline in routine practice to treat chronically constipated children. By releasing our protocolized behavioral intervention program and by offering a theoretical framework we expect to provide a good opportunity to evaluate clinical effectivity by both randomized controlled trials and qualitative research methods. Findings will contribute to the implementation of an effective treatment for chronic constipation in childhood.
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Affiliation(s)
- Marieke van Dijk
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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26
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Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006; 43:405-7. [PMID: 16954970 DOI: 10.1097/01.mpg.0000232574.41149.0a] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Constipation is a common pediatric problem. To assist health care professionals who care for children with constipation, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) previously published a clinical guideline based on an integration of medical evidence with expert opinion. To evaluate studies published since then, the NASPGHAN Constipation Guideline Committee performed a comprehensive and systematic review of the medical literature since 1997, to identify, review and rate the quality of new evidence. Based on this review, the recommendations of the original clinical guideline were reaffirmed with several modified according to the new evidence. Below is a summary of the evidence reviewed for this update. The complete revised guideline is available online in its entirety.
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Reid H, Bahar RJ. Treatment of encopresis and chronic constipation in young children: clinical results from interactive parent-child guidance. Clin Pediatr (Phila) 2006; 45:157-64. [PMID: 16528436 DOI: 10.1177/000992280604500207] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To describe the source of and treatment for encopresis in a series of 40 children under age 9 years. Referral for psychological based treatment followed upon limited success of standard gastroenterologic intervention. The treatment provided is defined as interactive parent-child family guidance. This includes a variety of specific psychologically based recommendations offered to parents, and, when indicated, direct interventions with the symptomatic child. These are different from various forms of behavioral corrective reward-punishment interventions frequently recommended for young children with encopresis. The pediatric and the psychological literature offer few reports of successful treatment of young children with this syndrome. Also, there are few specific descriptions of psychologically based interventions. The results reported here are of the successful treatment of 38 of 40 cases referred specifically for psychologically based intervention following the prior limited success of standard gastroenterologic treatment. The interactive parent-child family guidance intervention described in this report, differentiated from typical behavior therapies, is a notably successful mode of psychologically based therapy for these children. It offers an important alternative to standard pediatric gastroenterological treatment for encopresis, as well as to reward-punishment oriented behavioral therapies.
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Affiliation(s)
- Helen Reid
- Early Childhood Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
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Mellon MW, Whiteside SP, Friedrich WN. The relevance of fecal soiling as an indicator of child sexual abuse: a preliminary analysis. J Dev Behav Pediatr 2006; 27:25-32. [PMID: 16511365 DOI: 10.1097/00004703-200602000-00004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Encopresis is typically characterized as resulting from chronic constipation with overflow soiling but has been portrayed as an indicator of sexual abuse. The predictive utility of fecal soiling as an indicator of sexual abuse status was examined. In a retrospective analysis of three comparison groups of 4-12 year olds, we studied 466 children documented and treated for sexual abuse; 429 psychiatrically referred children with externalizing problems and 641 normative children recruited from the community, with the latter two samples having abuse ruled out. Standardized parent report measures identified soiling status and sexual acting out behaviors. Multiple regression analysis was used to predict abuse status in each group. Reported soiling rates were 10.3% (abuse), 10.5% (psychiatric), and 2% (normative), respectively. The soiling rate in the abused group differed significantly from that of the normative group, but not from the psychiatric group. Similar rates of soiling were reported among abused children, with and without penetration, and the psychiatric sample. Rates of sexualized behavior were reported significantly more often by the abused group versus both the psychiatric and normative groups and were a better predictor of abuse status. The positive predictive value of soiling as an indicator of abuse was 45% versus 63% for sexual acting out. The psychiatric sample displayed significantly more dysregulated behavior than the sexually abused sample. The predictive utility of fecal soiling as an indicator of sexual abuse in children is not supported. Soiling seems to represent one of many stress-induced dysregulated behaviors. Clinicians should assume the symptom of soiling is most likely related to the typical pathology and treat accordingly.
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Affiliation(s)
- Michael W Mellon
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Affiliation(s)
- M A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.
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Yang LM, Lin JB, Zhao YL, Liang JL, Lin H, Zhong Z, Chen RW, Xie JF, Liu FY, Wu ZR. Effects of biofeedback training by EMG on patients with chronic functional constipation. Shijie Huaren Xiaohua Zazhi 2004; 12:730-733. [DOI: 10.11569/wcjd.v12.i3.730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study characteristics of anorectal pressure, EMG activity and effect of biofeedback training system on patient with chronic functional constipation (CFC).
METHODS: Anorectal manometry was carried out in 144 cases of CFC by a monitor system (liquid-phase type) and Biolab dynamics parameter before and after the biofeedback training. 20 healthy individuals were taken as control.
RESULTS: Compared with controls, CFC patients showed slightly lower anal quiesent pressure (P>0.05), lower anorectal sphincteric squeezing pressure (15.7±1.4 vs 12.7± 1.4) (P < 0.01), higher rectal defection volume thresholds and higher rectal maximum talerable volume thresholds (12±6.2 vs 14.9±6.6; 29.3±6.8 vs 36.0±7.3) (P < 0.01; P < 0.01); EMG assessments showed that 100% patients with CFC had the contradictory movement between the pelvic floor muscle (PFM) and abdominal anterior oblique muscle (AAOM). The movement extent of the PFM rose from 5.3±2.8 to 10.2±2.8 under quiet state (P < 0.01), and AAOM reduced from 34.4±5.2 to 30.8±4.9 (P < 0.01); All the abnormalities significantly improved with Orion PC/ 12 m EMG biofeedback training therapy. After biofeedback training therapy, symptoms of CFC patients were improved with efficient rate of 84.03%; With increase of the treatment time and shortenning of the interval and assistant training, the curative efficacy rose and the recurrence rate reduced (78.8% vs 91.7%; 69.2% vs 92.8%) (P < 0.05; P < 0.05).
CONCLUSION: CFC patients have abnormal anorectal pressure, sensation threshold and unusual anus electric activities. Biofeedback training therapy can improve the above-mentioned indexes and is effective in 84.03% of the patients. The relatively intensive long-time training can improve the curative rate in a short period, and family assistant training can reduce the recurrance rate of the disease.
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N/A, 林 济, 赵 延, 林 红, 钟 智, 陈 荣, 谢 俊, 吴 志. N/A. Shijie Huaren Xiaohua Zazhi 2004; 12:202-204. [DOI: 10.11569/wcjd.v12.i1.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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Ritterband LM, Cox DJ, Walker LS, Kovatchev B, McKnight L, Patel K, Borowitz S, Sutphen J. An Internet intervention as adjunctive therapy for pediatric encopresis. J Consult Clin Psychol 2003; 71:910-7. [PMID: 14516239 DOI: 10.1037/0022-006x.71.5.910] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study evaluated the benefits of enhanced toilet training delivered through the Internet for children with encopresis. Twenty-four children with encopresis were randomly assigned to the Internet intervention group (Web) or no Internet intervention group (No-Web). All participants continued to receive routine care from their primary care physician. The Web participants demonstrated greater improvements in terms of reduced fecal soiling, increased defecation in the toilet, and increased unprompted trips to the toilet (ps<.02). Both groups demonstrated similar improvements in knowledge and toileting behaviors. Internet interventions may be an effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format.
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Affiliation(s)
- Lee M Ritterband
- Department of Psychiatric Medicine, Center for Behavioral Medicine Research, University of Virginia Health System, Charlottesville, VA 22908 USA.
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Wang J, Luo MH, Qi QH, Dong ZL. Prospective study of biofeedback retraining in patients with chronic idiopathic functional constipation. World J Gastroenterol 2003; 9:2109-13. [PMID: 12970917 PMCID: PMC4656685 DOI: 10.3748/wjg.v9.i9.2109] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the efficacy and long-term outcome of biofeedback treatment for chronic idiopathic constipation and to compare the efficacy of two modes of biofeedback (EMG-based and manometry-based biofeedback).
METHODS: Fifty consecutive contactable patients included 8 cases of slow transit constipation, 36 cases of anorectic outlet obstruction and 6 cases of mixed constipation. Two modes of biofeedback were used for these 50 patients, 30 of whom had EMG-based biofeedback, and 20 had manometry-based biofeedback. Before treatment, a consultation and physical examination were done for all the patients, related information such as bowel function and gut transit time was documented, psychological test (symptom checklist 90, SCL90) and anorectic physiological test and defecography were applied. After biofeedback management, all the patients were followed up. The Student’s t-test, chi-squared test and Logistic regression were used for statistical analysis.
RESULTS: The period of following up ranged from 12 to 24 months (Median 18 months). 70% of patients felt that biofeedback was helpful, and 62.5% of patients with constipation were improved. Clinical manifestations including straining, abdominal pain, bloating, were relieved, and less oral laxative was used. Spontaneous bowel frequency and psychological state were improved significantly after treatment. Patients with slow and normal transit, and those with and without paradoxical contraction of the anal sphincter on straining, benefited equally from the treatment. The psychological status rather than anorectal test could predict outcome. The efficacy of the two modes of biofeedback was similar without side effects.
CONCLUSION: This study suggests that biofeedback has a long-term effect with no side effects, for the majority of patients with chronic idiopathic constipation unresponsive to traditional treatment. Pelvic floor abnormalities and transit time should not be the selection criteria for treatment.
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Affiliation(s)
- Jun Wang
- Department of Colorectal Surgery, Tianjin Binjiang Hospital, Tianjin 300022, China.
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Amendola S, De Angelis P, Dall'oglio L, Di Abriola GF, Di Lorenzo M. Combined approach to functional constipation in children. J Pediatr Surg 2003; 38:819-23. [PMID: 12720201 DOI: 10.1016/jpsu.2003.50174] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/PURPOSE The authors' 15-year experience with children shows a high percentage of recurrence of functional constipation (FC) with conventional treatment. These data, confirmed in the international literature, led them to develop a new therapeutic approach. The aim of this study was to achieve intestinal control and avoid recurrence of FC in children through use of medical-psychological treatment. METHODS The authors studied 25 children (18 boys; mean age, 4.7 years; range, 2.10 to 7), 20% of whom had anal fissure, 30% retentive soiling, 52% pain on defecation, and 88% fecal retention owing to FC. Children and parents were questioned about eating and sleeping habits, school, toilet training, and daily routine. Treatment included increasing water and fiber intake, laxatives, and family therapy including making rules and working on autonomy and paternal role. RESULTS Mean onset of FC was 3.5 years, after "stressful events" in 88%. The questionnaire shows that 68% lacked parental autonomy and authority; 84% of children decided on their own about eating habits and sleeping; 68% had a "peripheral" father with a mother-child symbiotic relationship. After one month of therapy, 92% of children showed a modification of at least 2 behavioral patterns; after 3 months, 88% had regular bowel movements. During follow-up (range, 6 to 28 months), 48% had 2 or 3 recurrent episodes. After one year, 68% had reinforced the new behavioral patterns with resolution of the pathologic aspects. CONCLUSIONS A multidisciplinary approach in the treatment of childhood functional constipation showed consistent therapeutic results by making rules and by equalizing family roles.
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Affiliation(s)
- S Amendola
- Digestive Surgery, Endoscopic Unit, Department of Gastroenterology, Bambino Gesù Children's Hospital, Rome, Italy
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Abstract
A careful history and physical examination will help to differentiate between encopresis with or without constipation and fecal incontinence caused by anatomic or organic disease. Most children with encopresis with or without functional constipation require no or minimal laboratory workup. Successful treatment of encopresis requires a combination of parent and child education, behavioral intervention, medical therapy, and long-term compliance with the treatment regimen. The conventional treatment approach consists of behavior modification and laxative for children with encopresis with constipation and behavior modification alone for the few children with encopresis without constipation. Almost every patient will experience dramatic improvement in encopresis. Recovery rates are 30% to 50% after 1 year and 48% to 75% after 5 years.
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Affiliation(s)
- Vera Loening-Baucke
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Iowa, Iowa City, 52242-1083, USA.
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Lancioni GE, O'Reilly MF, Basili G. Treating Encopresis in People with Intellectual Disabilities: a Literature Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2001. [DOI: 10.1046/j.1468-3148.2001.00058.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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