The article aims to provide a state of knowledge in the literature on encopresis in the child psychiatric population. The general definition of the symptom and its analysis are presented according to ...different approaches. Then, the clinic of encopresis is described according to its specificities. The main associated disorders and psychiatric/psychosocial risk factors are discussed in detail. Regarding patient care, the multidisciplinary approach, including the complementarity with the paediatrician, is essential in a number of cases. Finally, family approach and the impact of trauma would be interesting research perspectives.
Children with autism spectrum disorder (ASD) are often delayed in achieving bowel continence, resulting in negative outcomes. In this pilot trial, 20 children with ASD and encopresis were randomly ...assigned to multidisciplinary intervention for encopresis (MIE; n = 10) or a waitlist control group (n = 10). The MIE group was treated for constipation and received a 10-day behavioral intervention that utilized suppositories to produce predictable bowel movements that were reinforced. Caregivers were trained to implement the intervention. Results support the feasibility of clinical trials of MIE, with high enrolment, competition, attendance, and caregiver acceptability. Preliminary outcomes were positive, with six of 10 in the MIE group achieving continence by the end of treatment compared to 0 in the control group (
p
= 0.005).
Registered at clinicaltrials.gov (
https://clinicaltrials.gov
); ID: NCT02383732.
Introduction and aim. The evaluation of functional results, complications and problems of children with Hirschsprung’s disease treated with one-stage surgery (TEPT) or two-stage surgery (colostomy, ...TEPT) in Paediatric Surgery Clinic in Rzeszow. Material and methods. Medical documentation of 41 children treated due to Hirschsprung’s disease in years 2006-2018 in Rzeszow were retrospectively analysed. The results of the questionnaires conducted among the parents of operated children were surveyed. Results. The average time of the radical surgery was 189 minutes. The mean length of the resected intestine in the classic form was 19 centimeters, in long-segment 35 centimeters. In the post-operative period, 15 patients had a blood transfusion. The mean time of the children’s stay calculated from the date of surgery until the discharge equaled 13.4 days. Early post-operative complications: enterocolitis occurred in 6 patients (1 death in a septic shock mechanism), total dehiscence of anastomosis in 1 patient, abscess of perirectal space in 1 patient, anastomotic retraction in 1 patient and in 3 patients inaccurate intra-operative evaluation of the section (intra), buttock dermatitis appeared in all patients. Late post-operative complications (a control trial of 38 patients): Soiling was confirmed in 9 patients, periodic constipation in one. The abnormal consistency of stool was signaled in 3 children. Two children were repetitively hospitalized due to enterocolitis. The frequency of defecation almost in all patients was reduced after a three, four-month period since the operation from 10-15 per day to the age norm. In one child, where the retraction of the anastomosis was diagnosed, the soiling and heightened frequency of defecation throughout the day persists. All of the parents of the older children view the outcome of the surgery as positive and the life quality of their children does not differ from their peers. Conclusion. TEPT is a method which can be performed in newborns, infants, babies as well as in case of a long-segment aganglionosis. Barium enema is not reliable in evaluation of the length of the aganglionic section in the long-segment type of Hirschsprung’s disease. The treatment of choice in the early post-operative enterocolitis should be colostomy. Worse functional results were observed in children after two-stage treatment – especially, in cases where the colostomy was created due to the intestinal re-distention.
One of the most striking examples of decompensation of oppositional-defiant disorder among children is encopresis (protest or infantile). Most often it represents a primitive hysterical reaction ...connected with its “conditional desirability” as a mean of liberation from any difficult situation for the child, which requires a fundamentally different approach in therapy. In encopresis treatment of an inorganic nature as well as other forms of behavioural, neurotic or psychosomatic protest there are rational, behavioural, family, play and suggestive therapy used together or separately. However, these methods are more effective in combination with emotional-stress psychotherapy used to a certain degree as early as possible.
Pediatric elimination disorders are common in childhood, yet psychosocial correlates are generally unclear. Given the physiological concomitants of both enuresis and encopresis, and the fact that ...many children with elimination disorders are initially brought to their primary care physician for treatment, medical evaluation and management are crucial and may serve as the first-line treatment approach. Scientific investigation on psychological and behavioral interventions has progressed over the past couple of decades, resulting in the identification of effective treatments for enuresis and encopresis. However, the body of literature has inherent challenges, particularly given the multicomponent nature of many of the treatment packages. This review identified 25 intervention studies-18 for nocturnal enuresis and 7 for encopresis-over the past 15 years and classified them according to the guidelines set forth by the Task Force on the Promotion and Dissemination of Psychological Procedures. For nocturnal enuresis, the urine alarm and dry-bed training were identified as well-established treatments, Full Spectrum Home Therapy was probably efficacious, lifting was possibly efficacious, and hypnotherapy and retention control training were classified as treatments of questionable efficacy. For encopresis, only two probably efficacious treatments were identified: biofeedback and enhanced toilet training (ETT). Best practice recommendations and suggestions for future research are provided to address existing limitations, including heterogeneity and the multicomponent nature of many of the interventions for pediatric elimination disorders.
Purpose: We investigated the patient background, treatment strategy and results in patients with chronic functional constipation.Method: Cases of chronic functional constipation managed in our ...hospital from January to December 2018 were collected and reviewed on the basis of medical records.Results: The study population included 48 patients (male, n = 26; female, n = 22); 16 cases were initial visits for consultation; 32 were revisits. The age at initial hospital consultation was 42 months. The age at the onset of constipation was 7.5 months, and the mean duration of sickness was 30.8 months. The presence/absence of self-defecation, defecation suppression and encopresis at the first visit was observed in 26/22, 38/10 and 16/32 patients, respectively. At the onset of symptoms, patients with encopresis were significantly older than those without encopresis (p = 0.027). At the first hospital visit, patients with encopresis were significantly older than those without encopresis (p = 0.0001). The duration of constipation in patients with encopresis was significantly longer than that of patients without encopresis (p = 0.017). The prevalence of developmental disorders was significantly higher in patients with encopresis than in those without encopresis (p = 0.00364). Defecation suppression improved in 30 of 38 patients (78.9%), but encopresis remained in 10 of 16 patients (62.5%). Dairy restriction was effective in 25 of 35 (71.4%) patients.Conclusion: Patients with encopresis were older at the onset of symptoms and the duration of constipation was relatively long; thus, early treatment may improve their symptoms. In addition to conventional constipation treatment, cooperation with pediatric neurologists is necessary for their management.
Purpose It is recognized that there is a strong association between bladder and bowel dysfunction. We determined the association of constipation and/or encopresis with specific lower urinary tract ...conditions. Materials and Methods We reviewed our database of children with lower urinary tract dysfunction and divided cases into 3 categories of bowel dysfunction (constipation, encopresis and constipation plus encopresis) and 4 lower urinary tract conditions (dysfunctional voiding, idiopathic detrusor overactivity disorder, detrusor underutilization disorder and primary bladder neck dysfunction). Associations between bowel dysfunction types and each lower urinary tract condition were determined. Results Of 163 males and 205 females with a mean age of 8.5 years constipation was the most common bowel dysfunction (27%). Although encopresis is generally thought to reflect underlying constipation, only half of children with encopresis in this series had constipation. Dysfunctional voiding was associated with the highest incidence of bowel dysfunction. All but 1 patient with encopresis had associated urgency and detrusor overactivity, and the encopresis resolved in 75% of patients after initiation of anticholinergic therapy. Constipation was significantly more common in girls (27%) than in boys (11%, p <0.01), while encopresis was more common in boys (9%) than in girls (3%, p = 0.02), likely reflecting the higher incidence of dysfunctional voiding in girls and idiopathic detrusor overactivity disorder in boys. Conclusions Active bowel dysfunction was seen in half of the children with a lower urinary tract condition. Constipation was more common in patients with dysfunctional voiding, while encopresis was significantly increased in those with idiopathic detrusor overactivity disorder and in those with dysfunctional voiding, severe urgency and detrusor overactivity. Anticholinergics, despite their constipating effect, given for treatment of detrusor overactivity resolved encopresis in most children with this bowel dysfunction.
Achieving continence of one's bowel movements is a key step in development and failure to do so leads to many negative consequences. Treatments for encopresis appearing in the literature have ...employed behavioral strategies; medications such as suppositories, laxatives, or enemas; and in some studies a combination of these approaches. To date, attempts to extend successful treatments for encopresis in typically developing children to those with developmental disabilities have been limited. The current study included three participants diagnosed with developmental disabilities who had a history of encopresis. None of the participants had a continent bowel movement under baseline conditions. Continent bowel movements increased during treatment that included the addition of suppositories to elicit continent bowel movements. Two participants began having independent continent bowel movements (i.e., without requiring suppositories) and medication was successfully faded out for the remaining participant. Treatment took between 13 and 21 days.
PURPOSEBladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to ...determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis.MATERIALS AND METHODSThis was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores.RESULTSA total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US $40,830.00) in the neuropsychiatric developmental disorder group.CONCLUSIONSThis study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.
BACKGROUND:Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and ...management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines.
METHODS:Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation.
RESULTS:This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children.
CONCLUSIONS:This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.