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Soliman A, AboAli SEM, Abdel Karim AE, Elsamahy SA, Hasan J, Hassan BAA, Mohammed AH. Effect of adding telerehabilitation home program to pharmaceutical treatment on the symptoms and the quality of life in children with functional constipation: a randomized controlled trial. Eur J Pediatr 2024:10.1007/s00431-024-05639-8. [PMID: 38922435 DOI: 10.1007/s00431-024-05639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 06/27/2024]
Abstract
Painful defecation, the passage of hard stools, unpleasant or irregular bowel deviation/movements from regular rate, and/or the feeling of not enough elimination of stool are common symptoms of functional constipation. The goals in treating constipation are to produce soft, painless stools and to prevent the re-accumulation of feces. This study looked at how the telerehabilitation home program (TRP) affected the symptoms of FC and the children who were constipated in terms of their quality of life. A randomized controlled trial included 400 children aging 4-18 years with functional constipation distributed in two groups: control group consisted of 200 children receiving pharmaceutical treatment and the intervention group consisted of 200 children receiving the telerehabilitation home program in addition to pharmaceutical treatment. Both groups received the interventions for 6 months. The outcomes in terms of functional constipation symptoms and quality of life are measured and compared pre- and post-interventions. Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in the condition; there is a significant difference between the intervention and control group in all Rome criteria which assess symptoms of functional constipation except rush to the bath-room to poop which showed non-significant difference; there is also a significant difference between the intervention and control group in all domains of the SF-36 questionnaire which assess quality of life except the mental health domain which showed non-significant difference. CONCLUSION Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in symptoms of functional constipation and quality of life. TRIAL REGISTRATION Our study was registered retrospectively with Clinicaltrials.gov under the identifier NCT06207721 on 5 January 2024. WHAT IS KNOWN • Painful defecation, passage of hard stools, unpleasant or irregular bowel movements, feeling of incomplete stool elimination are common symptoms of functional constipation. • Goals in treating constipation include producing soft, painless stools and preventing re-accumulation of feces. WHAT IS NEW • Adding telerehabilitation home program to pharmaceutical treatment resulted in significant improvement in functional constipation symptoms and quality of life. • Significant differences between intervention group (200 children receiving telerehabilitation home program in addition to pharmaceutical treatment) and control group (200 children receiving pharmaceutical treatment) were observed in all Rome criteria except for rush to the bathroom to poop, and in all domains of SF36 questionnaire except for the mental health domain.
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Affiliation(s)
- Amir Soliman
- Department of Public Health and Community Medicine, Faculty of Medicine, Delta University for Science and Technology, Gamasa, Egypt
| | - Safy Eldin M AboAli
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, October University for Modern Sciences and Arts, Giza, Egypt
| | - Amel E Abdel Karim
- Department of Physical Therapy for Pediatrics, Misr University for Science and Technology, Giza, Egypt
| | - Sara A Elsamahy
- Basic Science Department, Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | - Judy Hasan
- Dakahlia STEM School, Al-Mansoura, Egypt
| | - Badr Al-Amir Hassan
- Department of Physical Therapy for Internal Medicine and Geriatrics, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Amira H Mohammed
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt.
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Zahed G, Fatahi S, Tabatabaee L, Imanzadeh N, Seraj SS, Wolters BH, Hosseini A. Efficacy of atypical antipsychotics in the treatment of fecal incontinence in children and adolescents: a randomized clinical trial. BMC Pediatr 2024; 24:7. [PMID: 38172808 PMCID: PMC10763209 DOI: 10.1186/s12887-023-04474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Functional retentive overflow incontinence (retentive FI) is the most common cause of fecal soiling in children. Based on the clinical experiences, the treatment of retentive FI in patients with comorbid psychiatric disorders was accelerated when Risperidone was used as treatment for their psychiatric comorbidities; therefore, this study was conducted to evaluate the effect of risperidone in the treatment of retentive FI in children and adolescents. METHODS In this double-blind, randomized, placebo-controlled trial, 140 patients aged 4-16 years eligible for the study were randomized into two groups, receiving either 0.25-0.5 mg of Risperidone syrup (n = 70) or maltodextrin syrup (placebo group, n = 70) every 12 h daily for 12 weeks. Sociodemographic data, including age, sex, weight, height, BMI, BMI z-score, and socioeconomic status, was recorded, and the number of nocturnal FI, diurnal FI, and painful defecations was measured. RESULTS 136 participants (69 on Risperidone and 67 on placebo) were included in the study. Mean age of participants in the intervention and placebo groups were 7.2 ± 2.4 years and 8.0 ± 3.1 years, respectively. The mean number of nocturnal FI (Ptrend=0.39) and diurnal FI (Ptrend=0.48) in patients without psychiatric comorbidities, and the number of painful defecations for participants with and without psychiatric comorbidities (P = 0.49, P = 0.47, respectively) were not significantly different between the groups, but a significant effect was observed in diurnal FI after Risperidone treatment in patients with psychiatric comorbidities (P < 0.001). CONCLUSION Risperidone, when used along with other non-pharmacological interventions, may be helpful in treating FI in pediatric patients with psychiatric comorbidities.
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Affiliation(s)
- Ghazal Zahed
- Department of child and adolescent psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somaye Fatahi
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Tabatabaee
- Department of child and adolescent psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Imanzadeh
- School of pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaikh Sanjid Seraj
- Royal Shrewsbury Hospital, Shrewsbury and Telford NHS Trust, Shrewsbury, Shropshire, SY3 8XQ, UK
| | | | - Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
Constipation is a common problem encountered in the pediatric setting. For many children, constipation is functional in nature-potentially stemming from a pattern of stool output that is infrequent or not fully productive (ie, incomplete stool evacuation)-and includes behavioral concerns like stool withholding. In many cases of functional constipation (FC), the pattern may have started in the toddler years during or before toilet training and may now be well established. Additional factors often include inadequate fluids and fiber, or excess dietary dairy or carbohydrates. In a small percentage of cases, constipation is a symptom of an underlying organic disease process. Laboratory tests and imaging may be helpful in determining most organic concerns. In the absence of an organic process, FC can be treated by properly educating families about the nature of FC as well as careful attention to dietary fiber and fluid intake, use of stool softeners, laxatives, and behavioral modifications. [Pediatr Ann. 2021;50(8):e320-e324.].
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Group Treatment of Fecal Incontinence: A Description of an Interdisciplinary Intervention. J Pediatr Gastroenterol Nutr 2019; 69:e70-e74. [PMID: 31058779 DOI: 10.1097/mpg.0000000000002372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20% to 60% of cases. A combined medical-behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group-based treatment for fecal incontinence in school-aged children, and to present a description of changes in treatment adherence rates that affect clinical effectiveness. METHOD Poop group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6-week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre- to post-treatment. Group sessions focus on the GI system, medication, toilet sitting posture, hydration, fiber, and behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed. RESULTS Nineteen families completed the 6-week protocol. Appropriate stool frequency was improved (P ≤ 0.01), and soiling was reduced (P ≤ 0.00). Medication adherence was also improved (P ≤ 0.04). Treatment results were maintained at 1-month follow-up. DISCUSSION A developmentally targeted intervention and interdisciplinary focus of treatment likely account for treatment successes. CONCLUSION Poop group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment.
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Morgan KE, Leroy SV, Corbett ST, Shepard JA. Complementary and Integrative Management of Pediatric Lower Urinary Tract Dysfunction Implemented within an Interprofessional Clinic. CHILDREN (BASEL, SWITZERLAND) 2019; 6:children6080088. [PMID: 31366055 PMCID: PMC6721344 DOI: 10.3390/children6080088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Abstract
Lower urinary tract dysfunction in children is a common multifactorial functional problem that often correlates with bowel dysfunction and behavioral disorders. Ideal management combines integrative therapies that optimize bladder and bowel habits, address behavioral issues, foster mind–body connection, and improve pelvic floor muscle dysfunction. Movement therapies that teach diaphragmatic breathing and relaxation, mind–body awareness, and healthy pelvic floor muscle function are vital for long-term symptom improvement in children. This paper outlines recommendations for integrative management of these patients and discusses a recently developed interprofessional clinic that aims to better meet these patients’ complex needs and to provide patients with an integrated holistic plan of care. Additional work is needed to scientifically assess these treatment models and educate providers across the various disciplines that evaluate and treat these patients.
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Affiliation(s)
- Kathryn E Morgan
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA.
| | - Susan V Leroy
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA
| | - Sean T Corbett
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA
| | - Jaclyn A Shepard
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, P.O. Box 800223, Charlottesville, VA 22908, USA
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Motaharifard MS, Jafari Z, Paknejad MS, Oveidzadeh L, Karimi M. Prevention and treatment of constipation in children from the perspective of Iranian traditional medicine. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 14:429-435. [PMID: 27854194 DOI: 10.1016/s2095-4964(16)60278-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Constipation is one of the most common complaints of children and a common cause of referrals to pediatricians. Numerous reasons for this disease have been mentioned in the Iranian traditional medicine (ITM). It is believed that this disorder is mostly due to the lack of consideration of the six essential principles (Setteh-ye-Zarurieah), which are necessary to maintain health and prevent disease. In this descriptive study we collected and classified the concepts related to the topic by reviewing reliable ITM text books. Scientific databases were also searched for the most commonly used herbs in the treatment of constipation. The results showed that, from the perspective of ITM, the first step in treating constipation in children is making lifestyle changes. This includes giving appropriate training in the six essential principles, and making modification in existing habits where necessary. In the next steps, using some herbal remedies for topical or oral administration is recommended. On the other hand, a few clinical trials have been done concerning the effects of herbal medicines on pediatric constipation. Therefore, ITM's preventive and curative strategies can provide an efficient and cost-effective way to address constipation in children. This study can serve as a preface to performing clinical studies in this field.
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Affiliation(s)
| | - Zahra Jafari
- Department of Traditional Medicine, Faculty of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Laleh Oveidzadeh
- Department of Traditional Medicine, Faculty of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehrdad Karimi
- School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Jarczyk KS, Pieper P, Brodie L, Ezzell K, D'Alessandro T. An Integrated Nurse Practitioner-Run Subspecialty Referral Program for Incontinent Children. J Pediatr Health Care 2018; 32:184-194. [PMID: 29289407 DOI: 10.1016/j.pedhc.2017.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/15/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Evidence suggests that urinary and fecal incontinence and abnormal voiding and defecation dynamics are different manifestations of the same syndrome. This article reports the success of an innovative program for care of children with incontinence and dysfunctional elimination. This program is innovative because it is the first to combine subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population and the first reported independent nurse practitioner-run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting. Currently, services for affected children are siloed in the aforementioned subspecialties, fragmenting care. METHODS Retrospective data on financial, patient satisfaction, and patient referral base were compiled to assess this program. RESULTS Analysis indicates that this model is fiscally sound, has similar or higher patient satisfaction scores when measured against physician-run subspecialty clinics, and has an extensive geographic referral base in the absence of marketing. DISCUSSION This model has potential transformative significance: (a) the impact of children achieving continence cannot be underestimated, (b) configuration of services that cross traditional subspecialty boundaries may have broader application to other populations, and (c) demonstration of effectiveness of non-physician provider reconfiguration of health care delivery in subspecialty practice may extend to the care of other populations.
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Sethi T. Constipation. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Investigating the Effect of Nurse-Centered Strategies on Functional Chronic Constipation of Children aged 3-14 years Referring to Imam Reza Clinic of Shiraz University of Medical Sciences in 2014. SHIRAZ E-MEDICAL JOURNAL 2017. [DOI: 10.5812/semj.14874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
The practice of pediatrics from an integrative framework is based on physician-patient relationship, informed by evidence, and approaches the health of children and their families from a broad perspective. This article reviews the basic principles of integrative pediatrics and summarizes data and integrative approaches to common pediatric conditions seen in the primary care setting.
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Affiliation(s)
- David K Becker
- Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero Street, 4th Floor, Box 1726, San Francisco, CA 94143-1726, USA.
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Orhan C, Kaya Kara O, Kaya S, Akbayrak T, Kerem Gunel M, Baltaci G. The effects of connective tissue manipulation and Kinesio Taping on chronic constipation in children with cerebral palsy: a randomized controlled trial. Disabil Rehabil 2016; 40:10-20. [PMID: 27793072 DOI: 10.1080/09638288.2016.1236412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to investigate the effects of connective tissue manipulation (CTM) and Kinesio Taping® (KT) on constipation and quality of life in children with cerebral palsy (CP). METHOD This study was designed as a randomized controlled trial. Forty children diagnosed with chronic constipation based on Rome III criteria were randomly assigned to CTM group [6 females, 7 males; 8 y 6 mo (SD = 3y 4 mo)], KT group [7 female, 7 male; 8y 7 mo (SD =3y 5 mo)] or control group [6 female, 7 male; 8y 3 mo (SD = 3y 6 mo)]. All patients were assessed with 7-day bowel diaries, Bristol Stool Form Scale (BSFS), Visual Analog Scale (VAS), and Pediatric Quality of Life Inventory (PEDsQL). Kruskal-Wallis, Wilcoxon's signed-rank, and Mann-Whitney U tests were used to determine intra-group and inter-group differences. The level of significance was p < 0.05. RESULTS Among the CTM, KT, and control groups, there were statistically significant differences regarding the changes in defecation frequency (2.46, 3.00, 0.30, ES 1.16, p < 0.001), duration of defecation (5.07, 5.35, 0.15, ES 2.37, p = 0.003), BSFS (1.84, 2.14, 0.07, ES 0.91, p < 0.001), VAS (4.83, 3.87, 0.23, ES 1.98, p < 0.001), and PEDsQL total scores (7, 14, 8.36, -0.85, ES 4.08, p < 0.001). CONCLUSIONS This study revealed that CTM and KT seem equally effective physiotherapy approaches for the treatment of pediatric constipation and these approaches may be added to bowel rehabilitation program. Implications for rehabilitation CTM and KT have similar effectiveness in alleviating the constipation-related symptoms and improving quality of life in children with CP. CTM and KT can be integrated into bowel rehabilitation programs. Considering the characteristics of patients, these treatment options can be used as an alternative of each other by physiotherapists.
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Affiliation(s)
- Ceren Orhan
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Ozgun Kaya Kara
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Serap Kaya
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Turkan Akbayrak
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Mintaze Kerem Gunel
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Gül Baltaci
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
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Abstract
Mind-body therapies are popular and are ranked among the top 10 complementary and integrative medicine practices reportedly used by adults and children in the 2007-2012 National Health Interview Survey. A growing body of evidence supports the effectiveness and safety of mind-body therapies in pediatrics. This clinical report outlines popular mind-body therapies for children and youth and examines the best-available evidence for a variety of mind-body therapies and practices, including biofeedback, clinical hypnosis, guided imagery, meditation, and yoga. The report is intended to help health care professionals guide their patients to nonpharmacologic approaches to improve concentration, help decrease pain, control discomfort, or ease anxiety.
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Yılmaz S, Bilgiç A, Hergüner S. Effect of OROS methylphenidate on encopresis in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2014; 24:158-60. [PMID: 24168715 DOI: 10.1089/cap.2013.0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Although encopresis shows a high rate of comorbidity in patients with attention-deficit/hyperactivity disorder (ADHD), the etiologic origin of this relationship and the effect of ADHD drugs on encopresis are unclear. In this chart review, we explored the effect of OROS long-acting methylphenidate (MPH) treatment on encopresis in children with ADHD. We also evaluated the relationship between the clinical variables of ADHD and encopresis. METHODS The sample consisted of 21 children and adolescents (20 boys and 1 girl) with encopresis and coexisting ADHD 7-15 years of age. Their clinical characteristics and baseline (visit 1) and end of the second months' (visit 2) Conners' Parent Rating Scale (CPRS) subscores were recorded. Retrospective clinician determinations were made using the Clinical Global Impressions-Severity subscale (CGI-S) for encopresis severity and the Clinical Global Impressions-Improvement subscale (CGI-I) for encopresis response. RESULTS According to the CGI-I, 14 subjects (71.4 %) showed much or very much improvement in their encopresis at the second visit. All of the CPRS scores showed a significant reduction during the second visit. No association was found between the CGI-I score and the changes in any of the CPRS scores. Baseline oppositional defiant disorder (ODD) and conduct disorder (CD) scores were correlated with the CGI-S score; however, no association was found between core ADHD symptom severity and the CGI-S score. With regard to the encopresis outcome, the baseline CD score was negatively correlated with the CGI-I score, and the baseline ODD score was prone to show a negative correlation with the CGI-I score. CONCLUSIONS These results suggest that coexisting behavioral problems may be a vulnerability factor based on the severity of encopresis, and that MPH treatment may have a positive effect on encopresis in children and adolescents with ADHD.
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Affiliation(s)
- Savaş Yılmaz
- Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram School of Medicine , Konya, Turkey
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The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial. BMC Pediatr 2013; 13:112. [PMID: 23914827 PMCID: PMC3750818 DOI: 10.1186/1471-2431-13-112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 06/17/2013] [Indexed: 12/13/2022] Open
Abstract
Background Functional constipation is a common disorder worldwide and is found in all paediatric age groups. Functional constipation can be caused by delayed colonic transit or dysfunction of the pelvic floor muscles. Standard medical care in paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training, along with the prescription of laxatives. Evidence to evaluate the effectiveness of pelvic physiotherapy for this complaint is lacking. Methods/design A two-armed multicentre randomised controlled trial has been designed. We hypothesise that the combination of pelvic physiotherapy and standard medical care will be more effective than standard medical care alone for constipated children, aged 5 to 17 years. Children with functional constipation according to the Rome III will be included. Web-based baseline and follow-up measurements, scheduled at 3 and 6 months after inclusion, consist of the numeric rating scale in relation to the perceived severity of the problem, the Strength and Difficulties Questionnaire and subjective improvement post-intervention (global perceived effect). Examination of the pelvic floor muscle functions, including digital testing and biofeedback, will take place during baseline and follow-up measurements at the physiotherapist. The control group will only receive standard medical care, involving at least three contacts during five months, whereas the experimental group will receive standard medical care plus pelvic physiotherapy, with a maximum of six contacts. The physiotherapy intervention will include standard medical care, pelvic floor muscle training, attention to breathing, relaxation and awareness of body and posture. The study duration will be six months from randomisation, with a three-year recruitment period. The primary outcome is the absence of functional constipation according to the Rome III criteria. Discussion This section discusses the relevance of publishing the study design and the development of the presented physiotherapy protocol. It also addresses difficulties when interpreting the literature with regard to the effectiveness of biofeedback, potential confounding, and future research indications. To our knowledge, this article is the first to describe the design of a randomised controlled trial among children with constipation to assess the effect of pelvic physiotherapy as an add-on to standard medical care. Trial registration Current Controlled Trials NL30551.068.09
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Silva CAG, Motta MEFA. The use of abdominal muscle training, breathing exercises and abdominal massage to treat paediatric chronic functional constipation. Colorectal Dis 2013; 15:e250-5. [PMID: 23375005 DOI: 10.1111/codi.12160] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/15/2012] [Indexed: 01/02/2023]
Abstract
AIM The effect of muscular training, abdominal massage and diaphragmatic breathing was compared with medical treatment in a prospective randomized trial of patients with chronic functional constipation. METHOD Patients aged 4-18 years old with functional constipation according to the Rome III criteria were randomized to physiotherapy or medical treatment. In the physiotherapy group, exercises (isometric training of the abdominal muscles, diaphragmatic breathing exercises and abdominal massage) were employed during 12 40-min sessions twice a week by a trained physiotherapist, with laxatives. Patients in the medication group were only given laxatives. Primary outcome measures were frequency of defaecation and faecal incontinence. The analysis was performed by intention-to-treat. RESULTS After 6 weeks of treatment, the frequency of bowel movements was higher in the physiotherapy group [5.1 (2.1) days/week] than in the medication group [3.9 (2.0) days/week] (P = 0.01). The frequency of faecal incontinence was no different between the groups [3.6 (1.9) days/week vs 3.0 (2.1) days/week] (P = 0.31). CONCLUSION The combined use of isometric training of abdominal muscles, breathing exercises and abdominal massage increased defaecation frequency after 6 weeks but faecal incontinence remained unchanged. Physiotherapy may be a useful treatment for constipation.
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Affiliation(s)
- C A G Silva
- Universidade Federal de Pernambuco, Recife, Brasil
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Sethi T. Constipation. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Garman K, Ficca M. Managing encopresis in the elementary school setting: the school nurse's role. J Sch Nurs 2011; 28:175-80. [PMID: 22140139 DOI: 10.1177/1059840511429685] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Encopresis is a medical condition that is associated with incontinence in children. It leads to frustration and anxiety in both parents and children due to the presenting symptoms and the inability to control elimination patterns. There is overwhelming concern among families that a child with encopresis will be ostracized from peers and will suffer long-term psychological effects. It is therefore important to define encopresis to include the etiology, prevalence, and treatment measures in order to ensure a positive outcome. In addition, as a child enters elementary school, the school nurse plays a vital role in assisting the child to reach educational goals and managing health concerns. This article will guide the reader through the origin and diagnosis of encopresis as well as the principles of management. It will also delineate the school nurse role in managing encopresis in the school setting.
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Affiliation(s)
- Kimberly Garman
- Chambersburg Area School District, Chambersburg, PA 17202, USA.
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Germán Errázuriz F, Francisca Corona E. Dolor abdominal de origen orgánico en niños y adolescentes. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bongers MEJ, van den Berg MM, Reitsma JB, Voskuijl WP, Benninga MA. A randomized controlled trial of enemas in combination with oral laxative therapy for children with chronic constipation. Clin Gastroenterol Hepatol 2009; 7:1069-74. [PMID: 19576297 DOI: 10.1016/j.cgh.2009.06.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 06/18/2009] [Accepted: 06/20/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS After 5 years of intensive oral laxative use, up to 30% of constipated children still have an unsuccessful outcome. Children refractory to oral laxatives might benefit from regular rectal evacuation by enemas. This randomized controlled trial compared the effects of additional treatment with rectal enemas (intervention) with conventional treatment alone (oral laxatives, control) in severely constipated children. METHODS In a tertiary hospital in the Netherlands, 100 children, aged 8-18 years, with functional constipation for at least 2 years were randomly assigned to intervention or control groups. The control group received education, behavioral strategies, and oral laxatives. The intervention group was also given 3 rectal enemas/week, reduced by 1 enema/week every 3 months. Outcome measures were defecation and fecal incontinence frequency and overall success at 12, 26, 39, and 52 weeks. Overall success was defined as 3 or more defecations/week and less than 1 fecal incontinence episode/week, irrespective of laxative use. RESULTS Defecation frequency normalized in both groups but was significantly higher in the intervention group compared with controls at 26 and 52 weeks (5.6 vs 3.9/week, P = .02, and 5.3 vs 3.9/week, P = .02, respectively). There were no significant differences between groups in reduction of fecal incontinence episodes (P = .49) and overall success rates (P = .67). After 1 year of treatment, the overall success rate was 47.1% in the intervention group versus 36.1% in the control group. CONCLUSIONS There is no additional effect of enemas compared with oral laxatives alone as maintenance therapy for severely constipated children.
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Affiliation(s)
- Marloes E J Bongers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
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Affiliation(s)
- Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands.
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