The problem of defecation disorders in children is underestimated and easily goes unrecognized: a cross-sectional study

Abstract

We aimed to study constipation and fecal incontinence in terms of prevalence, recognizing the disorders, help-seeking behavior, and associated symptoms. In this cross-sectional study, 240 children (8 to 18 years) from the general Dutch population completed a questionnaire about defecation disorders. After exclusions for anorectal/pelvic surgery or comorbidities, we analyzed 212 children. The prevalence of constipation was 15.6%; in a quarter of the cases, it co-occurred with fecal incontinence. We found 3% fecal incontinence without constipation. Even though children with a defecation disorder rated their bowel habits worse compared to children without defecation disorders (P < 0.001), 46% constipated children and 67% fecally incontinent children rated their bowel habits as good or very good. Moreover, 21 to 50% of children with a defecation disorder did not mention their symptoms to anybody. Interestingly, most constipated children had “normal” stool frequencies (64%) and consistencies (49%).Conclusion: The prevalence of constipation and fecal incontinence is quite high in children. Stool frequency and consistency is normal in half the constipated children, which may complicate the recognition of constipation. Finally, a considerable number of children does not recognize their disorders as constituting a problem and does not seek help, which leads to an underestimation of these disorders. What is Known: • Constipation and fecal incontinence are common in children, but their prevalence rates may be underestimated due to a variety of reasons.• Diagnosing these disorders remains challenging owing to the variety of symptoms and co-existence with other diseases. What is New: • The prevalence of constipation and fecal incontinence in children is high.• Many children do not recognize their defecation disorders as constituting a problem and do not seek help, which leads to an underestimation of the problem of these disorders.Electronic supplementary materialThe online version of this article (10.1007/s00431-018-3243-6) contains supplementary material, which is available to authorized users.

Reproducibility, feasibility and validity of the Groningen Defecation and Fecal Continence questionnaires

“…Regarding feasibility, the questionnaire proved easy to understand and easy to complete. This was illustrated by our trial runs, such as this study and other studies in samples of the Dutch general population [25,26] that yielded only a small number of remarks from the participants, none of which concerned the understandability of the questionnaire. Although the questionnaire consisted of a wide range of questions, on an average it only required 11 min to complete the adult version of the questionnaire and 8 min to complete the pediatric version.…”

“…At the end of the survey, in order to test feasibility, the adult participants of the test-retest survey were given the opportunity to remark on the contents of the questionnaire and their ability to complete the questionnaire. We also assessed the time required to fully complete the P-DeFeC and DeFeC questionnaires using data obtained from previously performed studies in the general population [25,26].…”

Prevalence of Defecation Disorders and their Symptoms is Comparable in Children and Young Adults: Cross-Sectional Study

“…A cross-sectional study was performed in the Dutch population and was conducted in compliance with the requirements of the local Medical Ethical Committee of the University Medical Center Groningen. As we described previously, respondents were randomly selected from a database of Dutch inhabitants by the external company Survey Sampling International, in Rotterdam, the Netherlands, between September and December 2015 [ 16 ]. Participants in this database were provided with a link that allowed them to participate in the study and to complete the questionnaire online.…”

Long-term functional outcomes and quality of life in patients with Hirschsprung's disease

“…Reference data for the P‐DeFeC and DeFeC questionnaires were available from studies that had been performed previously in the general Dutch population. This produced 1103 healthy children and adults who did not have a history of bowel surgery or somatic diseases that could influence their bowels.…”