Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children

Brazzelli, Miriam; Griffiths, Peter; Cody, June D; Tappin, David

doi:10.1002/14651858.cd002240.pub4

Cited by 85 publications

(55 citation statements)

References 55 publications

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“…In pediatrics, fecal incontinence has been defined as the voluntary or involuntary passage of feces into the underwear or in socially inappropriate places, in a child with a developmental age of at least 4 years [4]. It has been suggested that in otherwise healthy children, fecal incontinence is secondary to ‘overflow’, and therefore results from the presence of constipation [4–6]. Though this is the most common cause, it has recently been recognized that otherwise healthy children can also have fecal incontinence without any evidence of fecal retention, a group categorized as ‘functional non-retentive fecal incontinence’ (FNRFI) [4, 7, 8].…”

Section: Coexistence Of Constipation and Incontinence In Childrenmentioning

confidence: 99%

Coexistence of constipation and incontinence in children and adults

Nurko

Scott

2011

Best Practice & Research Clinical Gastroenterology

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The coexistence of constipation and fecal incontinence has long been recognized in pediatric and geriatric populations, but is grossly underappreciated in the rest of the adult population. In children, functional fecal incontinence is usually associated with constipation, stool retention and incomplete evacuation, and is frequently allied to urinary incontinence. Pathophysiology of the incontinence is incompletely understood, although both in children and adults, it is thought to be secondary to overflow, while in adults it may also be related to pelvic floor dysfunction and denervation. Incontinence has an important impact on quality of life and daily functioning, and in children may be associated with behavior problems. The treatment of underlying constipation usually results in improvement in incontinence. This review broadly addresses the epidemiology and pathophysiology of coexistent constipation and incontinence in both children and adults, and also reviews clinical presentation and treatment response in pediatrics.

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Section: Coexistence Of Constipation and Incontinence In Childrenmentioning

confidence: 99%

Coexistence of constipation and incontinence in children and adults

Nurko

Scott

2011

Best Practice & Research Clinical Gastroenterology

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“…Clinically, this subpopulation has a high incidence of severe constipation with co-occurring intermittent diarrhea or underwear staining, which is often described clinically as fecal incontinence or encopresis. Fecal incontinence in children is often associated with fecal retention (Brazzelli et al 2011, Hyman et al 2006, Rasquin et al 2006, Di Lorenzo 2006). One study in children with ASD demonstrated that soiling was radiographically associated with constipation (Afzal et al 2003).…”

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confidence: 99%

Rigid–Compulsive Behaviors are Associated with Mixed Bowel Symptoms in Autism Spectrum Disorder

Peters

Williams

Gorrindo

et al. 2013

J Autism Dev Disord

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Based on clinical experience, we hypothesized that rigid-compulsive behaviors are associated with severe constipation and co-occuring diarrhea or underwear staining in children with autism spectrum disorder. Using data from the Autism Treatment Network, we evaluated the association between these gastrointestinal (GI) symptoms and measures of rigid compulsive behavior in children ages 2-17. Following statistical correction, four of five primary measures were significantly associated with constipation and diarrhea or underwear staining, including parental report of repetitive behavior, parental report of compulsive behavior, clinician diagnosis of OCD, and report of rituals observed on the Autism Diagnostic Observation Schedule. This association could point to a causal connection between these symptoms or to a common biological pathway that impacts both gut and brain.

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“…To date, there has been little scientific evidence evaluating the effectiveness of pelvic physiotherapy (PPT) in childhood constipation [7,14,29,30]. Therefore we designed a two-armed multicentre randomised controlled clinical trial (RCT).…”

Section: Methodsmentioning

confidence: 99%

“…Approximately 50% of children show this abnormal defecation pattern [13]. Withdrawal of stool, hard painful defecation or fear of stool, resulting in a vicious circle, is the most commonly proposed explanation of the aetiology of dyssynergic constipation in children [4,7,12,14-16]. …”

Section: Introductionmentioning

confidence: 99%

“…The standard medical care (SMC) for FC children in routine paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training along with the prescription of laxatives, sometimes supported by disimpaction or a high fibre diet [7,10,14,17,18]. Despite intensive medical and behavioural treatment long-term follow-up studies have shown that 50% of the children still have complaints of constipation after five year follow up [19].…”

Section: Introductionmentioning

confidence: 99%

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The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial

et al. 2013

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BackgroundFunctional constipation is a common disorder worldwide and is found in all paediatric age groups. Functional constipation can be caused by delayed colonic transit or dysfunction of the pelvic floor muscles. Standard medical care in paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training, along with the prescription of laxatives. Evidence to evaluate the effectiveness of pelvic physiotherapy for this complaint is lacking.Methods/designA two-armed multicentre randomised controlled trial has been designed. We hypothesise that the combination of pelvic physiotherapy and standard medical care will be more effective than standard medical care alone for constipated children, aged 5 to 17 years. Children with functional constipation according to the Rome III will be included. Web-based baseline and follow-up measurements, scheduled at 3 and 6 months after inclusion, consist of the numeric rating scale in relation to the perceived severity of the problem, the Strength and Difficulties Questionnaire and subjective improvement post-intervention (global perceived effect). Examination of the pelvic floor muscle functions, including digital testing and biofeedback, will take place during baseline and follow-up measurements at the physiotherapist. The control group will only receive standard medical care, involving at least three contacts during five months, whereas the experimental group will receive standard medical care plus pelvic physiotherapy, with a maximum of six contacts. The physiotherapy intervention will include standard medical care, pelvic floor muscle training, attention to breathing, relaxation and awareness of body and posture. The study duration will be six months from randomisation, with a three-year recruitment period. The primary outcome is the absence of functional constipation according to the Rome III criteria.DiscussionThis section discusses the relevance of publishing the study design and the development of the presented physiotherapy protocol. It also addresses difficulties when interpreting the literature with regard to the effectiveness of biofeedback, potential confounding, and future research indications. To our knowledge, this article is the first to describe the design of a randomised controlled trial among children with constipation to assess the effect of pelvic physiotherapy as an add-on to standard medical care.Trial registrationCurrent Controlled Trials NL30551.068.09

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Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children

Abstract: Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children (Review)

Cited by 85 publications

References 55 publications

Coexistence of constipation and incontinence in children and adults

Coexistence of constipation and incontinence in children and adults

Rigid–Compulsive Behaviors are Associated with Mixed Bowel Symptoms in Autism Spectrum Disorder

The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial

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