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.pub3

Cited by 66 publications

(51 citation statements)

References 57 publications

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“…There is some evidence that the adjunct of behavioral interventions to laxative therapy, rather than laxative therapy alone, improves continence in children with functional fecal incontinence associated with constipation. [16][17][18] We developed a protocolized behavioral therapy (BT) for constipated children and their parents. The present study results aimed to evaluate this BT with laxatives compared with conventional treatment (CT).…”

mentioning

confidence: 99%

Behavioral Therapy for Childhood Constipation: A Randomized, Controlled Trial

et al. 2008

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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.

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confidence: 99%

Behavioral Therapy for Childhood Constipation: A Randomized, Controlled Trial

et al. 2008

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“…Therefore, quality-of-life assessments, using baseline generic and before/after disease-specific quality-of-life instruments, are important secondary outcome measures. 20 High success rates for placebo (60%) often are reported for pediatric and adult patients with functional gastrointestinal disorders. 23,24 Despite the high response rates for placebo, there is a paucity of placebo-controlled studies with large patient samples for pediatric patients with constipation.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Behavioral Therapymentioning

confidence: 99%

Nonpharmacologic Treatments for Childhood Constipation: Systematic Review

Tabbers¹,

Boluyt

Berger³

et al. 2011

Pediatrics

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OBJECTIVE:To summarize the evidence and assess the reported quality of studies concerning nonpharmacologic treatments for childhood constipation, including fiber, fluid, physical movement, prebiotics, probiotics, behavioral therapy, multidisciplinary treatment, and forms of alternative medicine. METHODS:We systematically searched 3 major electronic databases and reference lists of existing reviews. We included systematic reviews and randomized controlled trials (RCTs) that reported on nonpharmacologic treatments. Two reviewers rated the methodologic quality independently. RESULTS:We included 9 studies with 640 children. Considerable heterogeneity across studies precluded meta-analysis. We found no RCTs for physical movement, multidisciplinary treatment, or alternative medicine. Some evidence shows that fiber may be more effective than placebo in improving both the frequency and consistency of stools and in reducing abdominal pain. Compared with normal fluid intake, we found no evidence that water intake increases or that hyperosmolar fluid treatment is more effective in increasing stool frequency or decreasing difficulty in passing stools. We found no evidence to recommend the use of prebiotics or probiotics. Behavioral therapy with laxatives is not more effective than laxatives alone. CONCLUSIONS:There is some evidence that fiber supplements are more effective than placebo. No evidence for any effect was found for fluid supplements, prebiotics, probiotics, or behavioral intervention. There is a lack of well-designed RCTs of high quality concerning nonpharmacologic treatments for children with functional constipation.

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“…21 But, a recent meta-analysis and a cochrane study suggest that behavior therapy added to laxative therapy may improve symptoms of children with constipation-associated fecal incontinence. 31,32 Toilet training: This means a regular process of training a young child to use the toilet usually 10-15 min after a main meal. There is a natural reflex mechanism (gastrocecal, gastrocolic, and duodenocolic reflexes), which stimulates the urge to defe-cate and which works best.…”

Section: Behavioral Therapymentioning

confidence: 99%