UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstracts for References 2,5-10

of 'Chronic functional constipation and fecal incontinence in infants and children: Treatment'

2
TI
Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN.
AU
Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, Staiano A, Vandenplas Y, Benninga MA
SO
J Pediatr Gastroenterol Nutr. 2014;58(2):258.
 
BACKGROUND: Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines.
METHODS: Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to theclassification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation.
RESULTS: This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants<6 months of age and the other for older infants and children.
CONCLUSIONS: This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.
AD
Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
PMID
5
TI
Consultation with the specialist: encopresis: assessment and management.
AU
Schonwald A, Rappaport L
SO
Pediatr Rev. 2004;25(8):278.
 
AD
Developmental Medicine Center, Boston Children's Hospital, MA, USA.
PMID
6
TI
Constipation and encopresis in childhood.
AU
Abi-Hanna A, Lake AM
SO
Pediatr Rev. 1998;19(1):23.
 
AD
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
PMID
7
TI
Chronic constipation in children.
AU
Loening-Baucke V
SO
Gastroenterology. 1993;105(5):1557.
 
The evaluation of chronic constipation with or without encopresis must begin with a careful history. The intervals between bowel movements and the size and consistency of stools deposited into the toilet should be noted. Encopresis may be manifested as dirtying the underwear. The physical examination should include a rectal and neurological examination. No specific organic cause can be found in the majority of children. One or several anorectal physiological abnormalities have been found by us and others in 95% of children with idiopathic constipation. These abnormalities include impaired rectal and sigmoid sensation and decreased rectal contractility during rectal distention. The external anal sphincter and pelvic floor muscles may be abnormally contracted during straining for defecation, and the child may be unable to defecate a rectal balloon. Most patients will benefit from a program designed to clear stools, to prevent further impaction, and promote regular bowel habits. Fifty percent of patients will be cured after 1 year and 65%-70% after 2 years.
AD
Department of Pediatrics, University of Iowa, Iowa City.
PMID
8
TI
Guideline for the management of pediatric idiopathic constipation and soiling. Multidisciplinary team from the University of Michigan Medical Center in Ann Arbor.
AU
Felt B, Wise CG, Olson A, Kochhar P, Marcus S, Coran A
SO
Arch Pediatr Adolesc Med. 1999;153(4):380.
 
OBJECTIVE: To develop an evidence-based guideline for the primary pediatric care of children (birth to 18 years old) with idiopathic constipation and soiling.
DATA SOURCES: References were identified through a MEDLINE search from January 1975 through January 1998 to address 3 focus questions: (1) the best path to early, accurate diagnosis; (2) best methods for adequate clean-out; and (3) best approaches to promote patient and family compliance with management.
DATA SELECTION: Twenty-five references were identified.
DATA EXTRACTION: References were reviewed by a multidisciplinary team and graded according to the following criteria: randomized controlled trial; controlled trial, no randomization; observational study; and expert opinion. Evidence tables were developed for each focus question.
DATA SYNTHESIS: An algorithm and clinical care guideline were developed by consultation and consensus among team members. Emphasis was placed on methods to promote early identification of pediatric idiopathic constipation and soiling, to recognize points of referral, and to increase patient and family compliance with treatment through use of education, developmentally based interventions, and variables for tracking success of management.
CONCLUSION: An algorithm and guideline for pediatric idiopathic constipation and soiling are presented for use by primary care physicians.
AD
Division of General Academic Pediatrics, University of Michigan School of Medicine, Ann Arbor 48109-0406, USA. truefelt@umich.edu
PMID
9
TI
Clinical approach to fecal soiling in children.
AU
Loening-Baucke V
SO
Clin Pediatr (Phila). 2000;39(10):603.
 
Fecal soiling is common in childhood and can be caused by stool toileting refusal, fecal incontinence due to organic disease, or encopresis due to functional constipation. Anatomical, neurologic, and inflammatory causes for fecal soiling are ruled out by history and physical examination and, if necessary, by anorectal manometry, barium enema, and rectal biopsy. The initial treatment suggestion for children with stool toileting refusal is to put the child back into pull-ups or diapers. Most children with fecal soiling due to organic disease continue with some degree of incontinence despite optimal medical management. Antegrade enema administration helps those with severe fecal incontinence due to organic causes who do not respond to medical management. Successful treatment of constipation and encopresis requires a combination of medical therapy, nutritional intervention, behavioral intervention, and long-term compliance with laxative use. The combined treatment approach improves the constipation and encopresis in all patients who comply with the treatment program. In some children, cow's milk protein intolerance may be the cause. In them, cow's milk protein needs to be eliminated.
AD
The University of Iowa, Iowa City, USA.
PMID
10
TI
Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children.
AU
Brazzelli M, Griffiths PV, Cody JD, Tappin D
SO
Cochrane Database Syst Rev. 2011;
 
BACKGROUND: Faecal incontinence is a common and potentially distressing disorder of childhood.
OBJECTIVES: To assess the effects of behavioural and/or cognitive interventions for the management of faecal incontinence in children.
SEARCH METHODS: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 October 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. We contacted authors in the field to identify any additional or unpublished studies.
SELECTION CRITERIA: Randomised and quasi-randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of faecal incontinence in children.
DATA COLLECTION AND ANALYSIS: Reviewers selected studies from the literature, assessed study quality, and extracted data. Data were combined in a meta-analysis when appropriate.
MAIN RESULTS: Twenty one randomised trials with a total of 1371 children met the inclusion criteria. Sample sizes were generally small. All studies but one investigated children with functional faecal incontinence. Interventions varied amongst trials and few outcomes were shared by trials addressing the same comparisons.Combined results of nine trials showed higher rather than lower rates of persisting symptoms of faecal incontinence up to 12 months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78 to 1.58). This result was consistent with that of two trials with longer follow-up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal manometry to conventional treatment did not result in higher success rates in chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months).In one small trial the adjunct of behaviour modification to laxative therapy was associated with a significant reduction in children's soiling episodes at both the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR 0.20 CI 95% 0.06 to 0.65).
AUTHORS' CONCLUSIONS: There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of functional faecal incontinence in children. There was not enough evidence on which to assess the effects of biofeedback for the management of organic faecal incontinence. There is some evidence that behavioural interventions plus laxative therapy, rather than laxative therapy alone, improves continence inchildren with functional faecal incontinence associated with constipation.
AD
Division of Clinical Neurosciences, University of Edinburgh, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU.
PMID