Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Several studies have shown that behavioral problems can be associated with defecation and voiding disorders, although few studies have looked directly at a link between a diagnosis of attention-deficit/hyperactivity disorder (ADHD) and constipation or fecal incontinence. WHAT THIS STUDY ADDS:We identified an increased risk for both constipation and fecal incontinence in children with ADHD. In patients with concomitant ADHD and defecation disorders, more aggressive medical and behavioral treatment of the constipation or fecal incontinence may be warranted. abstract OBJECTIVE: Functional constipation and fecal incontinence are common childhood gastrointestinal conditions. Both conditions may be associated with behavioral problems. Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder of childhood, characterized by shortened attention span and hyperactivity. We hypothesize that a diagnosis of ADHD increases the risk for functional constipation and fecal incontinence. METHODS:A retrospective cohort study of children was performed by using the military health system database. Children of active-duty military personnel, aged 4 to 12 years, from October 2005 to September 2007, were included. ADHD, constipation, and fecal incontinence were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Relative risks and adjusted incidence rate ratios (IRRs) were calculated. A subgroup analysis of subjects receiving medical therapy was performed.RESULTS: There were 742 939 children identified in the study, 32 773 (4.4%) of whom had ADHD. Children with ADHD had an increased prevalence of constipation (4.1% of children with ADHD vs 1.5% children without ADHD; P , .001) and fecal incontinence (0.9% of children with ADHD vs 0.15% of children without ADHD; P , .0001). Children with ADHD had more visits than those without ADHD for both constipation (IRR 3.39; 95% confidence interval 2.59-4.43) and fecal incontinence (IRR 7.74; 95% confidence interval 5.01-11.98). Children with ADHD receiving medicinal therapy did not differ significantly from children with ADHD not receiving medicinal therapy on rates of constipation visits (P = .57) or fecal incontinence visits (P = .32). CONCLUSIONS:Children with ADHD are significantly more likely to have constipation and fecal incontinence. Medical therapy for ADHD does not impact visit rates for defecation disorders.

Medical Comorbidity of Attention-Deficit/Hyperactivity Disorder in US Adolescents

“…These results confirm those of previous clinical studies of ADHD comorbidity that have reported increased frequencies of allergies and asthma, 55,56 headaches and migraine, 57,58 enuresis, 40,41,43,59,60 and gastrointestinal or bowel problems. 47 The authors also confirm findings of prior community studies that document poorer health in general among those with ADHD, 2,18,22,34,61,62 as well as associations with specific medical conditions including allergies and asthma, 22,[34][35][36]39,[63][64][65] headaches/migraine, 22,34,66 enuresis, 42,44,45,67 and gastrointestinal/bowel problems. 22,46,67 The confirmation of comorbidity in the general population demonstrates that the associations are not an artifact of clinical samples that are characterized by more severe, comorbid conditions.…”

Children with congenital colorectal malformations often require special education or remedial teaching, despite normal intelligence

“…Firstly, a relationship between the learning problems and either the sustained attention problems or the psychiatric disorders could not be supported by our data. Secondly, we hypothesised that the problems could be associated with the bowel management, as a relationship between attention deficit disorder and constipation has been described in the literature . However, this hypothesis could not be confirmed with regression analysis.…”

Determining an optimal dose of linaclotide for use in Japanese patients with irritable bowel syndrome with constipation: A phase II randomized, double‐blind, placebo‐controlled study

“…Thus, chloride ions and bicarbonate ion are secreted into the intestinal lumen with concomitant secretion of fluid . The GC‐C receptor has a genetic polymorphism associated with attention deficit/hyperactive disorder which is highly comorbid with pediatric constipation . To our knowledge, the distribution pattern and functional role of this common polymorphism of GC‐C receptor gene has not been reported in healthy controls and patients with IBS‐C in the USA, Europe, or Japan .…”