Medline ® Abstracts for References 112,133,134
of 'Chronic functional constipation and fecal incontinence in infants and children: Treatment'
Randomised trial of biofeedback training for encopresis.
van der Plas RN, Benninga MA, Redekop WK, Taminiau JA, Büller HA
Arch Dis Child. 1996;75(5):367.
AIMS: To evaluate biofeedback training in children with encopresis and the effect on psychosocial function.
DESIGN: Prospective controlled randomised study. PATIENT INTERVENTIONS: A multimodal treatment of six weeks. Children were randomised into two groups. Each group received dietary and toilet advice, enemas, oral laxatives, and anorectal manometry. One group also received five biofeedback training sessions.
MAIN OUTCOME MEASURES: Successful treatment was defined as less than two episodes of encopresis, regular bowel movements, and no laxatives. Psychosocial function after treatment was assessed using the Child Behaviour Checklist.
RESULTS: Children given laxatives and biofeedback training had higher success rates than those who received laxatives alone (39% v 19%) at the end of the intervention period. At 12 and 18 months, however, approximately 50% of children in each group were successfully treated. Abnormal behaviour scores were initially observed in 35% of children. Most children had improved behaviour scores six months after treatment. Children with an initial abnormal behaviour score who were successfully treated had a significant improvement in their behavioural profiles.
CONCLUSIONS: Biofeedback training had no additional effect on the success rate or behaviour scores. Psychosocial problems are present in a subgroup of children with encopresis. The relation between successful treatment and improvement in behavioural function supports the idea that encopresis has an aetiological role in the occurrence and maintenance of behavioural problems in children with encopresis.
Academic Medical Centre, University of Amsterdam, The Netherlands.
Lack of benefit of laxatives as adjunctive therapy for functional nonretentive fecal soiling in children.
van Ginkel R, Benninga MA, Blommaart PJ, van der Plas RN, Boeckxstaens GE, Büller HA, Taminiau JA
J Pediatr. 2000 Dec;137(6):808-13.
OBJECTIVES: To determine whether the combination of laxative treatment and biofeedback therapy (BF) is more effective for management of functional nonretentive fecal soiling than biofeedback therapy alone.
STUDY DESIGN: In a prospective nonblinded study, 48 children were randomized in 2 groups: treatment with oral laxatives (LAX) and 5 sessions of BF (BF + LAX) or 5 sessions of BF alone (BF) during a treatment intervention period of 7 weeks. Biofeedback was performed with perfused manometry catheters and rectal balloon distension. Training focused on awareness of balloon distension and instruction in correct defecation dynamics. Successful treatment was defined as<1 encopresis episode per 2 weeks.
RESULTS: At the end of the intervention period, the number of encopresis episodes was significantly decreased in both groups: from 7 (2 to 24) to 2 (0 to 17) in the BF group and from 7 (3 to 25) to 2 (0 to 14) in the BF + LAX group. However, children given BF alone had significantly higher success rates than children treated with BF and additional oral laxatives (44% to 11%).
CONCLUSIONS: There is no additional effect of laxative treatment in functional nonretentive fecal soiling. Children treated with BF in combination with laxatives showed a significantly lower success percentage compared with those treated with BF alone. These results suggest that children with functional nonretentive fecal soiling should be treated differently from children with constipation and encopresis.
Division of Pediatric Gastroenterology and Nutrition, the Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Functional nonretentive fecal incontinence: do enemas help?
Burgers R, Reitsma JB, Bongers ME, de Lorijn F, Benninga MA
J Pediatr. 2013 May;162(5):1023-7. Epub 2012 Nov 16.
OBJECTIVE: To assess the current treatment of functional nonretentive fecal incontinence, which consists of education, toilet training, and positive motivation.
STUDY DESIGN: Patients, age 6 years and older, referred for fecal incontinence (FI) and diagnosed with functional nonretentive fecal incontinence were eligible candidates. Seventy-one children (76% boys, median age 9.3 years) were randomized to receive conventional therapy (control group) or conventional therapy in addition to daily enemas during 2 weeks. Treatment success was defined as<2 episodes of FI/month without use of enemas.
RESULTS: At intake, the median FI frequency was 6.1 per week, whereas the median defecation frequency was 7.0 per week. At the end of the treatment period, the median number of FI episodes was significantly decreased in both groups: from 7.0 (IQR 4.0-11.5) to 1.0 (IQR 0.5-2.0) in the intervention group and from 6.0 (IQR 4.0-10) to 2.0 (IQR 0.5-3.5) in the control group. No statistical difference was found between the groups at the end of the treatment period (P = .08) nor during additional follow-up (average success rate 17% for both groups, P = .99).
CONCLUSION: Temporarily application of additional rectal enemas did not significantly improve treatment success compared with conventional therapy alone.
Department of Pediatrics, Emma Children's Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands. Electronic address: email@example.com.