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

Medline ® Abstracts for References 9,15,83,126,127

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

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
15
TI
Controversies in the management of chronic constipation.
AU
Loening-Baucke V
SO
J Pediatr Gastroenterol Nutr. 2001;32 Suppl 1:S38.
 
AD
Department of Pediatrics, University of Iowa, Iowa City, USA.
PMID
83
TI
Children with encopresis: a study of treatment outcome.
AU
Levine MD, Bakow H
SO
Pediatrics. 1976;58(6):845.
 
A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.
AD
PMID
126
TI
Diagnostic dilemmas and results of treatment for chronic constipation.
AU
Keuzenkamp-Jansen CW, Fijnvandraat CJ, Kneepkens CM, Douwes AC
SO
Arch Dis Child. 1996;75(1):36.
 
Chronic functional constipation (CFC) may be difficult to recognise and information regarding its long term prognosis is scarce. The records of 244 children with CFC, aged 0-18 years, were analysed for symptoms at presentation and results of treatment, and long term outcome was evaluated by means of a telephone interview in 137 patients discharged for more than one year. The patients presented with a great variety of symptoms, only 22% having infrequent defecation of increased consistency, another 22% having an obviously normal defecation pattern. The mean duration of treatment was 13 months. At the time of discharge, 69% of the patients still used laxatives. At a median of four years after discharge, 66% of the children were free of symptoms and without medication, 39% having experienced a recurrence. It is concluded that CFC may be difficult to recognise and can be alleviated by an intensive laxative regimen. Recurrence of symptoms is common, but the long term prognosis is good in most patients.
AD
Department of Paediatrics, Free University Hospital, Amsterdam, The Netherlands.
PMID
127
TI
Chronic constipation in childhood: a longitudinal study of 186 patients.
AU
Abrahamian FP, Lloyd-Still JD
SO
J Pediatr Gastroenterol Nutr. 1984;3(3):460.
 
One hundred eighty-six patients with chronic constipation and soiling were seen between 1975 and 1982. On follow-up, 47% had resolution of symptoms, with another 36% having their soiling controlled with either continuous or intermittent laxatives. Thirteen clinical features were analyzed in relation to outcome. The only predictor of poor outcome was the presence of soiling (p = 0.003), while the presence of abdominal pain correlated well with cure (p = 0.007). Fifty-five percent of patients had a positive family history for constipation. Significant psychological problems were present in 20% of patients; however, these did not appear to affect the outcome. Constipation was uncommon over the age of 12 years, and there was no evidence of the development of laxative dependence. These findings suggest that chronic idiopathic constipation of childhood may be a constitutional condition which tends to resolve with age.
AD
PMID