Medline ® Abstracts for References 16,24,107
of 'Chronic functional constipation and fecal incontinence in infants and children: Treatment'
Curr Opin Pediatr. 2002;14(5):570.
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.
Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Iowa, Iowa City, 52242-1083, USA. email@example.com
Rockney R. Encopresis. In: Developmental Behavioral Pediatrics, 3rd, Levine MD, Carey WB, Crocker AC (Eds), WB Saunders, Philadelphia 1999. p.413.
no abstract available
Prevalence and associated clinical characteristics of behavior problems in constipated children.
van Dijk M, Benninga MA, Grootenhuis MA, Last BF
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.
MSc, Emma Children's Hospital, Academic Medical Center, Psychosocial Department, Room G8-224, PO Box 22700, 1100 DE Amsterdam, Netherlands. firstname.lastname@example.org