Impact of Neurodevelopmental Disorders on Bowel Management Outcomes in Children with Functional Constipation

Abstract

Objectives: Patients experiencing functional constipation (FC) can participate in structured bowel management programs (BMPs) to manage constipation or fecal incontinence when standard management fails. We sought to evaluate the efficacy of BMPs for children with FC with and without neurodevelopmental disorders. Methods: We performed a retrospective review of children with FC who participated in our BMP from 2014 to 2021. Stool/urinary continence, bowel regimen, surgical history, parent-reported outcomes measures (PROMs: Cleveland Clinic Constipation Score, Baylor Continence Scale, Vancouver Symptom Score for Dysfunctional Elimination), and Pediatric Quality of Life Inventory (PedsQL) were assessed pre-and at least 9 months post-BMP. Results: The cohort included 156 patients with a median age of 9 years and follow-up of 627 days (IQR: 389-808 days). Two sub-cohorts included patients with FC only (69%) and FC plus a neurodevelopmental disorder (31%): 59% attention-deficit/hyperactivity disorder, 33% autism spectrum disorder, and 8% obsessive-compulsive disorder. Both groups had significantly improved follow-up bowel movement frequency and continence (39%-90% neurodevelopmental, 44%-82% FC only, P < 0.001) and urinary continence (65%-90% neurodevelopmental, 69%-91% FC only, P < 0.02). There was a significant improvement in most of the PROMs at follow-up. Both groups experienced a clinically meaningful improvement in overall PedsQL scores (pre-and postBMP difference of >4.5). Conclusions: Patients with FC with and without a neurodevelopmental disorder had significant improvement in stool and urinary continence after undergoing a BMP. Further studies are needed to see if this improvement is durable over a longer period of time in this challenging cohort.

State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation

“…Of patients with FC referred to a pediatric surgeon, 26-38% are neurodiverse with an associated neurologic (12%) or psychiatric (26%) diagnosis or behavioral concerns [48][49][50]. The statement that these conditions can affect the continence potential remains controversial [18,51,52] with only developmental delay having been reported to be associated with a worse prognosis for continence [18].…”

“…Anxiety and developmental delay have been reported to be associated with increased use of antegrade continence enemas (ACEs) in FC patients [52]; however, there is no significant difference in the time required to achieve continence between neurodiverse and neurotypical patients [53]. Recently, Seidler et al reported that participation in a dedicated BMP led to significant improvement of FC (up to 90%) and urinary continence (up to 91%) in both neurodiverse and neurotypical patients [50].…”

JPGN and the Year 2022

“…A retrospective review of 156 patients (median age of 9 years and follow-up of 627 days) with functional constipation who participated in structured bowel management programs (BMPs) was conducted (18). The two sub-cohorts included patients with functional constipation only (69%) and functional constipation plus a neurodevelopmental disorder (31%): 59% attention-deficit/ hyperactivity disorder, 33% ASD, and 8% obsessive-compulsive disorder.…”