Treating functional nonretentive fecal incontinence using a comprehensive behavioral treatment across settings.

Abstract

Objective: Research identifying effective treatments for functional nonretentive fecal incontinence (FNRFI) is limited, making the establishment of empirical evidence-based practice parameters difficult. The purpose of the current study is to add to the literature by examining the effects of a comprehensive behavioral treatment for three children with FNRFI. Method: A comprehensive behavioral treatment involving education about FNRFI, regularly scheduled brief toilet sits, a reward system contingent on successful bowel movements in the toilet, and a cleanup procedure for fecal accidents was implemented at home and at school with three children (age range = 9-12 years), experiencing chronic fecal incontinence with no history of constipation or stool retention and concurrent behavior problems related to toileting. A nonconcurrent multiple baseline design across participants was used to evaluate the effects of the treatment on participants' frequency of soiling, frequency of successful bowel movements in the toilet, and percentage of self-initiated successful bowel movements in the toilet. Results: The treatment resulted in improvements in all three participants' fecal incontinence. Specifically, participants achieved full fecal continence after at least 7 weeks of treatment and maintained gains following the withdraw of the treatment. Conclusion: Results indicate that a comprehensive behavioral intervention implemented across settings can have a profound positive impact on children's FNRFI. Implications for Impact StatementResearch identifying effective treatments for youth experiencing fecal incontinence without constipation or stool retention (i.e., functional nonretentive fecal incontinence) is limited. This study found that a comprehensive behavioral treatment involving education, regularly scheduled brief toilet sits, a reward system, and a cleanup procedure for fecal accidents, implemented at home and school, effectively reduced the frequency of fecal accidents, increased the frequency of successful bowel movements in the toilet, and increased the independent toileting for three children with functional nonretentive fecal incontinence.