Behavioral Therapy for Childhood Constipation: A Randomized, Controlled Trial

Abstract

Stool-withholding behavior is probably the major cause for development and/or persistence of childhood constipation. There is some evidence that the adjunct of behavioral interventions to laxative therapy, rather than laxative therapy alone, improves continence in children with constipation. What This Study AddsThis is the first large, randomized, controlled trial evaluating the effectiveness of behavioral therapy in constipated children. The study showed that conventional treatment should remain the first choice of treatment. When behavioral problems are present, behavioral therapy should be considered. ABSTRACTOBJECTIVE. It has been suggested that the addition of behavioral interventions to laxative therapy improves continence in children with functional fecal incontinence associated with constipation. Our aim was to evaluate the clinical effectiveness of behavioral therapy with laxatives compared with conventional treatment in treating functional constipation in childhood.

Nonpharmacologic Treatments for Childhood Constipation: Systematic Review

“…The sample sizes of the studies ranged from 31 11 to 134. 12 Table 2 presents the characteristics of the studies included. No RCTs on the effects of physical movement, multidisciplinary treatment, or alternative medicine (acupuncture, homeopathy, mind-body therapy, musculoskeletal manipulations such as osteopathic and chiropractic manipulations, or spiritual therapies such as yoga) for children with constipation were found.…”

“…All studies were hospital-based; 3 were conducted in a general pediatric department 14,18,19 and 6 were conducted in a pediatric gastroenterology department. [11][12][13][15][16][17] The studies were highly diverse with regard to the participants, interventions, and outcome measures; therefore, a meta-analysis of all included studies could not be performed. Consequently, we discuss all studies separately, including their most important methodologic shortcomings.…”

“…One subsequent high-quality RCT compared behavioral therapy by a child psychologist (learning process to reduce phobic reactions related to defecation, which consisted of 5 sequential steps, ie, know, dare, can, will, and do) and conventional treatment by a pediatric gastroenterologist (education, diary, and toilet training with a reward system) over 22 weeks (12 visits). 12 The study fulfilled all important criteria for validity. Both groups used similar laxative therapy.…”

“…20 An additional search found 42 studies, of which 1 RCT met our inclusion criteria. 12 The systematic review included 1 lowquality RCT that compared behavioral interventions (education) and a system of rewards from a pediatrician with monthly psychotherapy with a child psychiatrist. 19 The method of randomization was not stated clearly.…”

Do Educational Interventions with Mothers Enhance the Quality of Life of their Children with Chronic Functional Constipation in a Randomized Trial?

“…This treatment has not been considered successful, since only 5 to 6 patients are cured from a total of 10, due to the influence of biopsychosocial factors [7,11]. Therefore, the opportunity to reserve a time to exchange experiences with other mothers can contribute to their comprehension and reflection on the foundations of a complex problem and on biopsychosocial conflicts experienced by their children.…”