Functional Fecal Incontinence in Children

Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Thapar, Nikhil; Benninga, Marc A.

doi:10.1097/mpg.0000000000003056

Cited by 18 publications

(13 citation statements)

References 71 publications

(102 reference statements)

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“…Fecal incontinence (FI), also known as encopresis or soiling, is one of the common gastrointestinal problems in children. It indicates the passage of the stool in the underwear by children four years of age and older who have completed toilet training (1). Initially, FI was considered only for children with neurological disabilities, but further studies showed that approximately one to four percent of four-year-old children (2) and one to two percent of children aged ten to sixteen years old experienced FI (3).…”

Section: Introductionmentioning

confidence: 99%

Emotional, Behavioral and Social Problems in Children with Fecal Incontinence by Child Behavior Checklist (CBCL): A Cross-sectional Study

Hosseini¹,

Mirbazel²,

Zeinali³

et al. 2022

J Compr Ped

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Background: Fecal incontinence (FI) is a stressful condition for children and their parents that may affect the patient’s psychological well-being. Evaluating the patients’ psychological status may help physicians manage the disease effectively. Objectives: This study aimed to assess the emotional and behavioral disturbances in children with FI who were referred to the pediatric gastroenterology clinic in Mofid Children’s Hospital from April 2021 to 2022. Methods: This cross-sectional study included children (over four years old) with chronic constipation and fecal incontinence. The diagnosis of chronic constipation and FI were made according to Rome-IV criteria. The Child Behavior Checklist (CBCL) evaluated patients’ emotional, behavioral, and social problems. Results: One hundred one patients with a mean age of 7.96 years were enrolled in the study; 67.32% were males. According to CBCL, 12% (12 patients) indicated emotional and behavioral problems, with CBCL scores in the clinical or at-risk range. We detected anxious/depressed problems in five (4.95%), withdrawn/depressed problems in eight (7.92%), somatic complaints in seven (6.93%), social problems in eight (7.92%), thought problems in nine (8.91%), attention problems in seven (6.93%), rule-breaking behavior in two (1.98%), and aggressive behavior in nine (8.91%) patients. The risk of internalizing and externalizing disorders was reported in four (3.96%) and five (4.95%) patients. Also, eight (7.92%) and seven (6.93%) patients had clinical symptoms of internalizing and externalizing disorders, respectively. There was no significant relationship between patients’ age and gender with the CBCL scores in any subscales. However, there was a significant difference in the total score among the age groups (P = 0.04). Conclusions: The relatively high prevalence of emotional, behavioral, and social problems in our study corroborates the importance of psychological screening of children with FI during the treatment process.

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Section: Introductionmentioning

confidence: 99%

Emotional, Behavioral and Social Problems in Children with Fecal Incontinence by Child Behavior Checklist (CBCL): A Cross-sectional Study

Hosseini¹,

Mirbazel²,

Zeinali³

et al. 2022

J Compr Ped

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“…1 ) [ 2 , 11 – 20 ]. Both constipation and fecal incontinence are addressed by the EP-DeFeC as these conditions often go together in children [ 17 , 28 ]. The bowel function scores facilitate the clinical interpretation of the questionnaire, because only counting fecal incontinence episodes or knowing stool frequency does not necessarily differentiate between children with acceptable bowel function and those in need of medical attention.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of the Early Pediatric Groningen Defecation and Fecal Continence questionnaire

2022

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There are no compatible tools that assess bowel function in young children, older children, and adults. This precludes clinical follow-up and longitudinal scientific research. Our aim was therefore to develop and validate a bowel function questionnaire equivalent to the pediatric (8–17 years) and adult (≥ 18 years) Groningen Defecation and Fecal Continence (DeFeC) questionnaires for children from the age of 1 month to 7 years. We developed, validated, and translated the Early Pediatric Groningen DeFeC (EP-DeFeC) questionnaire according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). The EP-DeFeC incorporates different validated bowel function scoring systems, including the Rome IV criteria that are also included in the pediatric and adult DeFeC. We assessed feasibility and reproducibility by a test–retest survey. The study population (N = 100) consisted of the parents/caregivers of children whose median age was 4.0 (IQR 2.0–5.0) years. The mean interval between testing and retesting was 2.7 ± 1.1 months. None of the respondents commented on ambiguities regarding the questions. The overall median time taken to complete the EP-DeFeC was 8.7 min (IQR 6.8–11.8). The overall observed agreement was 78.9% with an overall kappa coefficient of 0.51, indicating moderate agreement.Conclusion: The EP-DeFeC is a feasible, reproducible, and validated questionnaire for assessing bowel function in children from the age of 1 month to 7 years. If used in combination with its pediatric (8–17 years) and adult (≥ 18 years) equivalents, this questionnaire enables longitudinal follow-up of bowel function from infancy to adulthood. What is Known:• Bowel function problems are common among young children.• Unfortunately, there are no compatible tools that assess bowel function in young children, older children, and adults, which precludes clinical follow-up and longitudinal scientific research. What is New:• The Early Pediatric Groningen Defecation and Fecal Continence (EP-DeFeC) questionnaire is validated to assess bowel function in children from the age of 1 month to 7 years.• If used together with its pediatric and adult equivalents, longitudinal follow-up of bowel function from infancy to adulthood becomes possible.

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“…The most frequent causes of childhood constipation are improper toilet training and withholding behavior ( 5 ). Young toddlers experiencing painful defecation, such as from hard stools, have a natural instinct to retain their feces.…”

Section: Classification and Etiologymentioning

confidence: 99%

“…The basic treatment is the first-line treatment option of FI in children and adolescents. It has been reported that 22%–54% of patients with FI achieve a high QoL through diet, toilet training, and cognitive behavioral therapy ( 5 ).…”

Section: Management Of Fi In Children and Adolescentsmentioning

confidence: 99%

“…Only 37.7% of children aged 5-6 years and 27.4% of children sought medical care for incontinence (3). A cluster of physical and psychological problems occur in FI patients, including repeated infections, skin ulcers and scars, social anxiety disorder, behavioral problems, self-abasement or isolation, and other problems, which lead to guilt and embarrassment (4)(5)(6). Currently, no consensus guidelines for diagnosis and management strategies of FI in children and adolescents exist, and the criteria for selecting optional methods had to learn from the practice guidelines in adults which could not cover all aspects of FI in children.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and management of fecal incontinence in children and adolescents

Shen

Zhang²,

Bai

et al. 2022

Front. Pediatr.

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Fecal incontinence (FI) is a commonly occurring disease of high concern. It is characterized by voluntary and involuntary defecation in children and adolescents. It is not only a physical disease but also a psychological and behavioral disorder. FI poses a serious burden on individuals and their families and therefore has become a social problem. Unfortunately, the management of FI among children is still a challenge because the etiology varies widely. Constipation has been found to be the most common cause, while sphincter dysfunction and neurogenic abnormalities may also play a role. Currently, no consensus guidelines exist, and the criteria for selecting optional methods remain unclear. It is therefore necessary to improve the efficacy of diagnosis and management strategies of FI in children. This review focused on the classification and etiology, discussed the diagnosis and management methods of FI in children and adolescents, and aimed to guide future studies.

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Functional Fecal Incontinence in Children

Cited by 18 publications

References 71 publications

Emotional, Behavioral and Social Problems in Children with Fecal Incontinence by Child Behavior Checklist (CBCL): A Cross-sectional Study

Emotional, Behavioral and Social Problems in Children with Fecal Incontinence by Child Behavior Checklist (CBCL): A Cross-sectional Study

Development and validation of the Early Pediatric Groningen Defecation and Fecal Continence questionnaire

Diagnosis and management of fecal incontinence in children and adolescents

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