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Burton LM, Skelton J, Harry O, Zuar L. Systematic review of family and pediatric constipation: An overlooked piece of the puzzle. J Pediatr Gastroenterol Nutr 2024; 79:309-314. [PMID: 38934411 DOI: 10.1002/jpn3.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
The objective of this review is to summarize pertinent literature looking at family dynamics and/or adherence to treatment in pediatric functional constipation. A structured systematic literature search was conducted on MEDLINE, Embase, and Web of Science core collection libraries from the years 2000 to 2023 using specific search terms: constipation, treatment adherence, family dynamics, parenting style, and pediatrics. Seventy-one publications were identified and included for review. After screening based on alignment to the review, 20 publications remained. These publications were placed into three categories depending on their intent and findings: (1) recommendations to further increase adherence, (2) studies analyzing factors of adherence, and (3) studies stating a need for a better understanding of family factors. A future area of research is identifying the associations between family factors on adherence to constipation treatment regimens. Results from such studies would increase the amount of positive treatment outcomes and decrease unnecessary healthcare costs.
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Affiliation(s)
- Landon M Burton
- Department of Biology, Wake Forest University, Winston-Salem, North Carolina, USA
- Wake Forest School of Medicine, Center for Prevention Science in Child and Family Health, Winston-Salem, North Carolina, USA
| | - Joseph Skelton
- Wake Forest School of Medicine, Center for Prevention Science in Child and Family Health, Winston-Salem, North Carolina, USA
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Onengiya Harry
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lynsey Zuar
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Osmanlı CÇ, Şahin B. Stool-toileting refusal in preschool age children: A follow-up study. J Pediatr Nurs 2024; 77:e426-e433. [PMID: 38762424 DOI: 10.1016/j.pedn.2024.05.006] [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: 01/11/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Stool-toileting refusal in preschool-aged children is a significant issue that strongly impacts both the child and the family, signaling a challenging period. We investigated the relationships between temperament, traumatic life events, parental sociodemographic characteristics, and psychological burdens and these behaviors. Our goal was to identify factors that may contribute to the chronicity of this stool-toileting refusal behavior. METHODS Conducted as a single-center, prospective, controlled design, the research involved children exhibiting stool-toileting refusal for at least one month, alongside healthy individuals of similar age and sex. Evaluation covered sociodemographic characteristics, parental psychopathologies, children's temperament features, and life events. Follow-up questionnaires, administered one year later, assessed stool-toileting refusal behavior. FINDINGS An evaluation at the end of one year revealed that stool-toileting refusal behavior persisted in 11 of the 31 children. A family history of constipation, comorbid enuresis in the child, maternal psychiatric disorders, and rhythmic temperament features were significantly higher than in the healthy group. Children with persistent stool-toileting refusal behavior exhibited notably lower activity levels. DISCUSSION The study's results indicated associations between the TSC rhythmicity score, comorbid constipation and enuresis, and maternal psychiatric illness in preschool-aged children with stool-toileting refusal behavior. A notable association was identified between the continuation of stool-toileting refusal behavior and a low TSC activity score. Advanced statistical methods did not reveal significant differences, highlighting the need for larger sample studies. IMPLICATIONS TO PRACTICE Applying the study's findings to clinical practice involves considering factors such as a family history of constipation, comorbid enuresis in the child, maternal psychiatric disorders, and rhythmic temperament features as potential indicators of persistent stool-toileting refusal in preschool-aged children, guiding healthcare professionals in tailored assessments and interventions.
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Affiliation(s)
- Cansu Çobanoğlu Osmanlı
- Department of Child and Adolescent Psychiatry, Giresun University Faculty of Medicine, Giresun, Turkey.
| | - Berkan Şahin
- Department of Child and Adolescent Psychiatry, Giresun University Faculty of Medicine, Giresun, Turkey
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McCague Y, Somanadhan S, Stokes D, Furlong E. The psychosocial implication of childhood constipation on the children and family: A scoping review protocol. HRB Open Res 2024; 6:48. [PMID: 38812827 PMCID: PMC11134151 DOI: 10.12688/hrbopenres.13713.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 05/31/2024] Open
Abstract
Background Constipation is a common problem in childhood that can have psychological, emotional, social, and health-related quality-of-life (HRQOL) consequences on children and their families. Primary or functional constipation (FC) has no known underlying pathology but is associated with lifestyle, psychological, and behavioural factors. Misdiagnosis and inadequate management of constipation can result in chronicity that can continue to adulthood, reducing quality of life for the child and their parents/family. It also causes emotional, psychological and emotional distress and concern for children and their families. This scoping review aims to answer the research question, "What has been reported about the psychosocial implication of childhood constipation among children and their families?" Methods The methodology for this scoping review will draw on the six stages of Arksey and O'Malley Framework and the updated and refined version by Peters et al. (2022). The process and reporting will follow the PRISMA-ScR guidelines. The Population, Concept and Context (PCC) framework will guide the development of inclusion criteria and the search strategy for this scoping review. Systematic literature searches of PUBMED, CINAHL, ASSIA, PsycInfo and Cochrane Library will be conducted from inception to present. The critical appraisal will be performed on selected articles to promote trustworthiness and methodological rigour. Plans for consultation exercise and dissemination of findings will also be presented. Conclusion This scoping review aims to present a comprehensive synthesis of the characteristics and extent of available literature to develop an understanding of and identify gaps in current knowledge regarding the psychosocial implication of childhood constipation on children and their families.
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Affiliation(s)
- Yvonne McCague
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Leinster, Ireland
| | - Suja Somanadhan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Leinster, Ireland
| | - Diarmuid Stokes
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Leinster, Ireland
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Leinster, Ireland
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Bedenik T, Cahir C, Bennett K. Building public trust and confidence in secondary use of health data for healthcare improvement and research: a qualitative study pre-protocol. HRB Open Res 2024; 6:47. [PMID: 38947251 PMCID: PMC11214037 DOI: 10.12688/hrbopenres.13711.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/02/2024] Open
Abstract
Background Secondary use of health data provides opportunities to drive improvements in healthcare provision, personalised medicine, comparative effectiveness research, health services innovation, and policy and practice. However, secondary data use requires compliance with relevant legislation, implementation of technical safeguards, ethical data management, and respect for data sharers. Existing evidence suggests widespread support for secondary use of health data among the public, which co-exists with concerns about privacy, confidentiality and misuse of data. Balancing the protection of individuals' rights against the use of their health data for societal benefits is of vital importance, and trust underpins this process. The study protocol explores how to build public trust and confidence in the secondary use of health data through all key stakeholder groups in Ireland, towards developing a culture that promotes a safe and trustworthy use of data. Methods This study will adopt a qualitative cross-sectional approach conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research COREQ guidelines. Participants in the study will include academics and researchers; healthcare professionals, data protection, ethics and privacy experts and data controllers; pharmaceutical industry and patients and public. Purposive and convenience sampling techniques will be utilised to recruit the participants, and data will be collected utilizing focus groups that may be supplemented with semi-structured interviews. Data will be coded by themes using reflexive thematic analysis (TA) and collective intelligence (CI) will be convened post-analysis to explore the preliminary findings with the participants. Ethics and Dissemination Ethical approval was obtained from the Royal College of Surgeons in Ireland Research Ethics Committee (REC202208013). Final data analysis and dissemination is expected by Q1 2024. Findings will be disseminated through peer-reviewed journal publications, presentations at relevant conferences, and other academic, public and policy channels. Lay summaries will be designed for Public and Patient Involvement (PPI) contributors and general public.
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Affiliation(s)
- Tina Bedenik
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, D02 DH60, Ireland
- Science Foundation Ireland (SFI) FutureNeuro Research Centre, Dublin, D02 YN77, Ireland
| | - Caitriona Cahir
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, D02 DH60, Ireland
| | - K. Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, D02 DH60, Ireland
- Science Foundation Ireland (SFI) FutureNeuro Research Centre, Dublin, D02 YN77, Ireland
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Zhou Q, Tang Y, Yuan L, Xu L, Yu L, Yu Z, Zhang Q. Establishment of a nomogram for predicting functional constipation among children in China: Using the Rome IV criteria. Arab J Gastroenterol 2023; 24:204-210. [PMID: 37532661 DOI: 10.1016/j.ajg.2023.05.003] [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: 05/12/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND STUDY AIMS Childhood functional constipation (FC) is gradually becoming an emerging public health problem. This study aimed to develop a personalized nomogram for the prediction of incident FC among Chinese children, and the diagnosis of FC was based on the Rome IV criteria. PATIENTS AND METHODS This cross-sectional study was conducted from Nov. 2020 to Jan. 2021 among children residing in Anhui province, China. An electronic questionnaire regarding the general demographic and clinical characteristics of all children was completed by their primary caregivers. The multivariate logistic regression analysis was applied to identify risk factors for FC. Moreover, a nomogram was constructed for FC based on the risk factors identified from the multivariate analysis. RESULTS In this study, a total of 901 electronic questionnaires were collected, of which 832 (92.3%) questionnaires were properly completed and included in the final analysis. The prevalence of FC among Chinese children was 11.3% based on the Rome IV criteria. After controlling for potential confounding factors, the multivariate logistic regression analysis showed that inadequate sleep, picky eating, and positive family history of FC were identified as key risk factors of FC. The area under the receiver operating characteristic curve of the nomogram was 0.694 (95 %CI: 0.6412-0.7459). Further, a calibration curve drawn illustrated that the predicted probabilities reasonably approximately the actual prevalence of FC in this population. CONCLUSION Inadequate sleep, picky eating, and positive family history of FC were identified as risk factors of FC. An easy-to-use nomogram was constructed based on these three significant factors. Besides, this nomogram was validated to have acceptable discrimination and calibration capabilities. Hence, this nomogram may enable clinical professionals to predict the risk of FC among Chinese children and further provide optimized disease prevention and intervention for this population.
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Affiliation(s)
- Qilian Zhou
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Yuxia Tang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Liping Yuan
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Lingling Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Lijuan Yu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Zhuchun Yu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Qianqian Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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Domínguez-Muñoz A, Bischoff A, Wehrli LA, Judd-Glossy L, Schneider L, Merritt A, Wickham M, Ketzer J, Rodriguez V, Peña A, De La Torre L. Radiologically supervised bowel management program outcome in patients with chronic idiopathic constipation. Pediatr Surg Int 2023; 39:229. [PMID: 37428259 DOI: 10.1007/s00383-023-05508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE This study aimed to analyze our radiologically supervised bowel management program (RS-BMP) outcomes in patients with chronic idiopathic constipation (CIC). METHODS A retrospective study was conducted. We included all patients with CIC who participated in our RS-BMP at Children´s Hospital Colorado from July 2016 to October 2022. RESULTS Eighty patients were included. The average time with constipation was 5.6 years. Before our RS-BMP, 95% had received non-radiologically supervised treatments, and 71% had attempted two or more treatments. Overall, 90% had tried Polyethylene Glycol and 43% Senna. Nine patients had a history of Botox injections. Five underwent anterograde continence procedure, and one a sigmoidectomy. Behavioral disorders (BD) were found in 23%. At the end of the RS-BMP, 96% of patients had successful outcomes, 73% were on Senna, and 27% were on enemas. Megarectum was detected in 93% of patients with successful outcomes and 100% with unsuccessful outcomes (p = 0.210). Of the patients with BD, 89% had successful outcomes, and 11% had unsuccessful. CONCLUSION Our RS-BMP has been proven to be effective in treating CIC. The radiologically supervised use of Senna and enemas was the appropriate treatment in 96% of the patients. BD and megarectum were associated with unsuccessful outcomes.
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Affiliation(s)
- Alfredo Domínguez-Muñoz
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Andrea Bischoff
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Lea A Wehrli
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Laura Judd-Glossy
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Lauren Schneider
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Anne Merritt
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Maura Wickham
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Jill Ketzer
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Víctor Rodriguez
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Alberto Peña
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Luis De La Torre
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA.
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Rajindrajith S, Devanarayana NM, Thapar N, Benninga MA. Myths and misconceptions about childhood constipation. Eur J Pediatr 2023; 182:1447-1458. [PMID: 36689003 DOI: 10.1007/s00431-023-04821-8] [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: 11/02/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
Many widely held beliefs and assumptions concerning childhood constipation continue to interfere with rational management of childhood constipation. Although many still believe that constipation is not a common disease, about 9.5% of the world's children suffer from chronic constipation. Most of these children live in non-Western countries. There are major misconceptions about the etiology of constipation as a significant proportion of clinicians still believe that constipation is caused by some form an organic pathology, whereas in reality, the majority have functional constipation. Contrary to a commonly held belief that children outgrow constipation without long-term problems, there is evidence that constipation leads to significant bowel and psychological consequences and has a major impact on the quality of life which detrimentally affects future health and education. Finally, ineffective management strategies such as increasing fiber and water in the diet, and short duration of treatment owing to the fear that long-term laxative treatment leads to colonic dysfunction, interfere with effective therapeutic strategies. Conclusions: It is apparent that myths and misconception often lead to wrong assumptions regarding the distribution of the disease, its etiology, pathophysiology, and management leading to ordering incorrect investigations and ineffective therapeutic strategies while spending large sums of public funds unnecessarily. Poorly treated constipation leads to deleterious psychological consequences predisposing children to develop significant psychological damage and bowel dysfunctions. This review aims to challenge these myths about various elements of constipation by exploring the existing literature and encouraging clinicians to have a fresh look at old concepts that could interfere with the well-being of children with constipation. What is Known: • Childhood constipation is a growing problem in the world leading to significant suffering and high healthcare expenditure • Myths and misconceptions lead to poor management strategies causing psychological and bowel damage What is New: • Organic, systemic, and bowel disorders leading to constipation are uncommon, and in the majority, it arises due to deliberate fecal withholding and most investigations ordered by clinicians are not very helpful in the management • Most non-pharmacological interventions are not effective in the day-to-day management of childhood constipation. The use of laxatives is considered to be the first-line management strategy.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka.
| | | | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University, of Amsterdam, Amsterdam, The Netherlands
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Cap-assisted endoscopic sclerotherapy is effective for rectal mucosal prolapse associated outlet obstructive constipation. Arab J Gastroenterol 2022:S1687-1979(22)00087-9. [DOI: 10.1016/j.ajg.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
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Shapouri S, Matani R, Salahshoor A, Qorbani M, Hosseini A, Norouzi M, Khavandegar A. Rectal measurements and their correlation with bowel habits: Evaluation by trans-abdominal ultrasound in children with functional constipation. J Paediatr Child Health 2022; 58:1792-1796. [PMID: 35778914 DOI: 10.1111/jpc.16104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 11/29/2022]
Abstract
AIM Constipation is one of the most common complaints in childhood affecting the quality of life of both children and parents. This study intends to investigate rectal measurements on ultrasound and their relationship with bowel habits. METHODS In this cross-sectional study, 100 children with functional constipation (FC) referred to a single hospital between 2018 and 2019 were enrolled. After obtaining informed consent, a questionnaire including demographic and constipation characteristics was completed, and a physical examination including digital rectal examination (DRE) was performed. Complete abdominopelvic ultrasound was then performed. Target measurements included rectal transverse diameter (RTD), rectal anterior wall thickness (RAWT) and the presence of faecal impaction. RESULTS One hundred children with a mean age of 7.68 ± 3.30 years were present in the study. The mean duration of constipation was 15.86 ± 13.34 months. In 14% of children, painful defaecation was reported. 88% of children had some degree of faecal incontinence. According to the ultrasound findings, the mean RTD and RAWT were 3.39 ± 0.73 cm and 2.77 ± 0.68 mm, respectively, and faecal impaction was present in 70% of cases. There was a positive correlation between RTD and RAWT with age, duration of constipation and the presence of hard stools, and there was a negative correlation with frequency of defecation (P < 0.05). CONCLUSION RTD and RAWT increased with increasing constipation duration and the presence of hard stools and decreased with increasing frequency of defaecation. DRE could be omitted from the initial clinical assessment if you had access to reliable ultrasound data.
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Affiliation(s)
- Samaneh Shapouri
- Pediatrics Medicine Department, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Rahman Matani
- Pediatrics Medicine Department, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Salahshoor
- Radiology Department, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Amirhossein Hosseini
- Pediatric Gastroentrology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Mahsa Norouzi
- Pediatrics Medicine Department, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Armin Khavandegar
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
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Rajindrajith S, Devanarayana NM, Benninga MA. Childhood constipation: Current status, challenges, and future perspectives. World J Clin Pediatr 2022; 11:385-404. [PMID: 36185096 PMCID: PMC9516492 DOI: 10.5409/wjcp.v11.i5.385] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/23/2021] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
- University Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 00800, Sri Lanka
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Amsterdam 1105AZ, The Netherlands
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Benzamin M, Karim ASMB, Rukunuzzaman M, Mazumder MW, Rana M, Alam R, Islam MM, Alam MS, Hossen K, Yasmin A, Fathema K, Khadga M, Aishy AS. Functional constipation in Bangladeshi school aged children: A hidden misty at community. World J Clin Pediatr 2022; 11:160-172. [PMID: 35433302 PMCID: PMC8985490 DOI: 10.5409/wjcp.v11.i2.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/02/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Constipation is a common problem in children and a frequent cause of hospital visit in both primary & specialized care, which needs proper evaluation & management. Presentation of constipation is variable among children. In Bangladesh there has been no published data regarding constipation in community among school aged children.
AIM To determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.
METHODS This descriptive cross sectional study was conducted in different schools of Dhaka division, Bangladesh. All school aged children between 5-16 years of age who attended school were included in this study. Samples were collected randomly. Proper clinical history & physical examinations (without digital rectal examination) & available investigations (if done previously) were recorded. Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation. Children with any red flag sign, known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded. Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20. For all statistical tests, P value of less than 0.05 was considered as statistically significant.
RESULTS Total study populations were 707 and male was 443 and female 264. Among them, 134 (19%) children had constipation. In constipated children, 78 children fulfilled the Rome IV criteria for functional constipation and it was 11% of total population. Mean age of children having functional constipation was 11.24 ± 3.54 years and Male female ratio was 1:1.78. Anorexia, nausea, abdominal pain, hard stool, blood with hard stool, alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group. Children of school, where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number (OR = 2.493, 95%CI: 1.214-5.120). Children who feel embarrassed to use toilet at school, had 3.6 times higher risk of constipation (OR = 3.552, 95%CI: 1.435-8.794). Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs (OR = 3.977, 95%CI: 1.884–8.397) and parents/grandparents (OR = 2.569, 95%CI: 1.172-5.629). Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake (OR = 1.972, 95%CI: 1.135-3.426). Children who passed electronic screen time of > 2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time < 2 h (OR = 2.138, 95%CI: 1.063-4.301).
CONCLUSION Constipation is not uncommon in Bangladeshi school aged children. Inadequate toilet number, family history of constipation, inadequate fluid intake, feeling embarrassed to use toilet at school, and electronic screen time for > 2 h/d were found as risk factors in the present study for functional constipation.
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Affiliation(s)
- Md Benzamin
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - ASM Bazlul Karim
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Md Rukunuzzaman
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Md Wahiduzzaman Mazumder
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Masud Rana
- Department of Outpatient, Hazi Asmot Medical Centre, Bhairab 2350, Bangladesh
| | - Rubaiyat Alam
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Mohammad Majharul Islam
- Department of Paediatric Nephrology, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Md Shafiul Alam
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Kamal Hossen
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Afsana Yasmin
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Kaniz Fathema
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Mukesh Khadga
- Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
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12
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Huang Y, Wang Y, Chen Y, Gu X, Yang J, Ma B, Zhang Y, Lu Q, Zhao Y. Measuring self-efficacy in defecation: Validation and utilization of a Chinese version of the self-efficacy for functional constipation questionnaire (SEFCQ) in a pediatric population. Neurogastroenterol Motil 2022; 34:e14255. [PMID: 34494345 DOI: 10.1111/nmo.14255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Self-efficacy in defecation plays an important role on behavioral therapy for functional constipation (FC). There is an unmet need for valid child self-report measures of task-specific self-efficacy for pediatric FC. Our aim was to cross-culturally validate the Self-Efficacy for Functional Constipation Questionnaire (SEFCQ) and to explore the salient factor(s) of self-efficacy in defecation that correlate with anxiety and constipation symptom severity among Chinese children. METHODS The SEFCQ was adapted to Chinese version following the Rome Foundation guidelines for the translation of questionnaires. Two hundred and three children with FC were involved in psychometric testing. Confirmatory factor analysis was conducted to determine the structure of the SEFCQ. Construct validity was evaluated by testing the relationship between the SEFCQ and both anxiety and the Patient Assessment of Constipation Symptoms (PAC-SYM). Test-retest reliability, internal consistency, and interfactor correlation were used to evaluate reliability. Hierarchical multiple regression was used to identify salient self-efficacy for FC that correlates with anxiety and constipation symptom severity. KEY RESULTS Confirmatory factor analysis supports the two-factor structure of the SEFCQ. Adequate test-retest reliability (r = 0.973, p<0.001) and internal consistency (Cronbach's α = 0.871) were obtained. Both self-efficacy factors were significantly associated with anxiety (r = -0.227 to -0.350, p<0.001) and PAC-SYM (r = -0.495 to -0.602, p<0.001), with emotional self-efficacy being the most salient factor for predicting the symptom severity of constipation after controlling for sex, age, quality of parents' marriage, and family history. CONCLUSION AND INFERENCES The SEFCQ showed satisfactory psychometric properties. Low self-efficacy in defecation correlates with anxiety and may contribute to poor adherence to behavior change, which exacerbates the symptoms of constipation. Further study is needed to apply social cognitive intervention to increase children's self-efficacy in defecation and assess its effect on treatment outcomes.
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Affiliation(s)
- Yaqi Huang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yulu Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Ying Chen
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaoling Gu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jin Yang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Bingxin Ma
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yanwen Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qi Lu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
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13
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Dos Santos IR, de Abreu GE, Dourado ER, Martinelli Braga AAN, Lobo VA, de Carvalho IWB, Bastos Netto JM, Barroso U. Emotional and behavioural problems in children and adolescents: The role of constipation. J Paediatr Child Health 2021; 57:1003-1008. [PMID: 33565678 DOI: 10.1111/jpc.15368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/29/2022]
Abstract
AIM The functional constipation (FC) is a source of an expressive suffering in children, negatively affecting their emotional, social, and physical well-being. The objective of this study is to describe the clinical and behavioural characteristics of children/adolescents with FC. METHODS A cross-sectional, observational, analytical study was conducted in public places by interviewing parents of children/adolescents about their child's bowel habits and psychological profile. Bowel symptoms were investigated using the Rome IV criteria. The Strengths and Difficulties Questionnaire (SDQ) was used to evaluate the emotional and behavioural problems. RESULTS Of 799 children/adolescents included, 424 (53.1%) were female. Mean age was 9.1 ± 2.7 years. FC prevalence was 20.4%. The most common symptoms in Rome IV criteria were 'painful or hard bowel movements' (n = 110; 67.5%; 95% confidence interval: 60.0-74.3) and 'retentive posturing or excessive volitional stool retention' (n = 89; 54.6%; 95% confidence interval: 46.9-62.1). Median scores for internalising symptoms (7; interquartile range (IQR): 4-9 vs. 5; IQR: 2-7; P < 0.001) and externalising symptoms (7; IQR 4-11 vs. 6; IQR 3-9; P < 0.001) were higher in constipated children compared to non-constipated participants, respectively. The SDQ domains that were associated with FC were emotional symptoms (median 4, P < 0.001) and conduct problems (median 3, P < 0.001). No association was found between faecal incontinence and median scores for the internalising/externalising symptoms. All Rome IV criteria were associated with abnormal overall SDQ scores. CONCLUSION Children and adolescents with FC had more emotional and behavioural problems irrespective of whether faecal incontinence was present or not, with higher scores for internalising and externalising symptoms compared to non-constipated children.
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Affiliation(s)
- Ivana R Dos Santos
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Glícia E de Abreu
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Eneida R Dourado
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Ana A N Martinelli Braga
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Victoria A Lobo
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | | | - José M Bastos Netto
- Division of Urology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Ubirajara Barroso
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.,Urology Department, Hospital das Clínicas, Federal University of Bahia, Salvador, Bahia, Brazil
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14
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Mattheus HK, Kiefer K, Freund R, Hussong J, Wagner C, Equit M, In-Albon T, Bolten MI, von Gontard A. Psychopathology and Parental Stress in 3-6-Year-Old Children with Incontinence. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2021; 49:249-258. [PMID: 33957759 DOI: 10.1024/1422-4917/a000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children's psychopathology especially in young children. Methods: Children's psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children's (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.
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Affiliation(s)
- Hannah K Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Kathrin Kiefer
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Rebecca Freund
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Catharina Wagner
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Monika Equit
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Margarete I Bolten
- Child and Adolescent Psychiatric Clinic, Department of Developmental Psychopathology, University of Basel, Switzerland
| | - Alexander von Gontard
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, The Netherlands.,Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland
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15
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Yıldırım A, Biçer Ş, Hacıhasanoğlu-Aşılar R, Özdamar MY, Şahin H, Gül V. The Effect of Education Given to Children with Functional Constipation and Fecal Incontinence and Their Mothers on Anxiety and Constipation Management. Florence Nightingale Hemsire Derg 2020; 28:321-332. [PMID: 34263211 PMCID: PMC8134022 DOI: 10.5152/fnjn.2020.19134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022] Open
Abstract
AIM This study aimed to determine the effect of multidimensional training program on children with constipation and fecal incontinence and their mothers on anxiety and their constipation management. METHOD The study had an experimental design with a pretest-posttest control group. The intervention group consisted of children diagnosed with functional constipation (n=20) and fecal incontinence (n=21) and their mothers in the Pediatric Surgery Clinic. The control group consisted of healthy (n=20) children who applied to two different Family Health Centers for any reason. Data were collected between February 2016 and June 2017 using a descriptive questionnaire, a nutrient consumption frequency form, the Rome III diagnostic criteria form, and the Trait Anxiety Scale for Children. RESULTS After the training program, the mean score of the Trait Anxiety Scale for Children decreased in both intervention groups (p<0.01) and increased in the control group (p<0.05). In addition, the frequency of the consumption of milk, caffeinated drinks, and white bread was reduced in the children of both intervention groups after the training program. The consumption of dried legumes, vegetables, and whole wheat bread increased. According to the Rome III diagnostic criteria, it was determined that constipation symptoms were not observed in 50% of the children. CONCLUSION The training program had a significant influence on the prevention and management of constipation and anxiety. Given that constipation is associated with both physical and mental health outcomes, the approach for the treatment should be holistic in nature, involving a multidisciplinary team.
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Affiliation(s)
- Arzu Yıldırım
- Department of Psychiatric Nursing, Yalova University Faculty of Health Sciences, Yalova, Turkey
| | - Şenol Biçer
- Department of Pediatric Surgery, Erzincan Binali Yildirim University School of Medicine, General Surgery, Erzincan, Turkey
| | | | - Mustafa Yaşar Özdamar
- Department of Pediatric Surgery, Erzincan Binali Yildirim University School of Medicine, General Surgery, Erzincan, Turkey
| | - Hilal Şahin
- Division of Dietetics, Department of Nutrition and Dietetics, Erzincan Binali Yildirim University Faculty of Health Sciences, Erzincan, Turkey
| | - Vahdet Gül
- Division of Medical Biochemistry / Internal Medicine, Department of Mental Health and Diseases, Erzincan Binali Yildirim University School of Medicine, Basic Medical Sciences, Erzincan, Turkey
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16
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Rajindrajith S, Ranathunga N, Jayawickrama N, van Dijk M, Benninga MA, Devanarayana NM. Behavioral and emotional problems in adolescents with constipation and their association with quality of life. PLoS One 2020; 15:e0239092. [PMID: 33044960 PMCID: PMC7549826 DOI: 10.1371/journal.pone.0239092] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/29/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives To assess behavioral and emotional problems in children and adolescents with functional constipation and their relationship with psychological maladjustment and health-related quality of life (HRQoL). Design A school-based cross-sectional survey conducted in 8 randomly selected schools from 4 randomly selected districts in Sri Lanka. A previously validated questionnaire was used for data collection. Behavioral and emotional problems were assessed using the Sinhala version of the Child Behavior Check List (CBCL-S/4-18). Constipation was diagnosed by applying the Rome III criteria. Results A total of 1000 questionnaires were distributed, and 913 completed questionnaires were included in the analysis. Sixty adolescents (6.5%) had functional constipation. Scores obtained for isolated psychological problems such as withdrawal (3.1 [3.1] vs. 1.9 [2.4], p<0.001), somatic complaints (3.2 [2.8] vs. 2.3 [2.5], p<0.05) anxiety/depression (5.8 [2.5] vs. 3.9 [3.6], p<0.001), social problems (3.0 [2.7] vs. 2.2 [1.9] p<0.001) and attention problems (5.4 [4.1] vs. 3.9 [3.4], p<0.001), and broadband scale of internalization (12.1 [8.4] vs. 8.3 [7.2], p<0.05) and mean total CBCL-S/4-18 score (29.4 [19.5] vs. 23.2 [17.0], p<0.001) were higher in adolescents with functional constipation. Clinical characteristics, socio-demographic and family factors and psychological maladjustment had no relationship with externalization, internalization and total CBCL-S/4-18 score. Internalization (-0.49, p<0.0001), externalization (-0.30, p<0.05), and total CBCL-S/4-18 (-0.44, p<0.001) scores had a negative impact on HRQoL of adolescents with functional constipation. Conclusions Adolescents with functional constipation are suffering from significant behavioral and emotional problems. These problems negatively affect their HRQoL.
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Affiliation(s)
- Shaman Rajindrajith
- Faculty of Medicine, Department of Pediatrics, University of Colombo, Colombo, Western Province, Sri Lanka
- The Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | - Nayomi Ranathunga
- Faculty of Medicine, Department of Physiology, Wyamba University of Sri Lanka, Kuliyapitiya, North Central Province, Sri Lanka
| | | | - Marieke van Dijk
- Psychological Department, Emma Children Hospital, Amsterdam University Medical Center, Meibergdreef, Amsterdam, The Netherlands
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Meibergdreef, AZ, Amsterdam, The Netherlands
| | - Niranga Manjuri Devanarayana
- Faculty of Medicine, Department of Physiology, University of Kelaniya, Ragama, Western Province, Sri Lanka
- * E-mail:
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17
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Ribeiro RS, Abreu GED, Dourado ER, Veiga ML, Lobo VA, Barroso U. BLADDER AND BOWEL DYSFUNCTION IN MOTHERS AND CHILDREN: A POPULATION-BASED CROSS-SECTIONAL STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:126-130. [PMID: 32401953 DOI: 10.1590/s0004-2803.202000000-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recently it was shown an association between lower urinary tract symptoms in mothers and their children. However, the role of functional constipation in this binomial is unclear. OBJECTIVE To evaluate bladder and bowel dysfunction between mothers and children. METHODS A population-based cross-sectional study. Mothers and their children responded a self-administrated questionnaire composed by Rome IV criteria, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System and demographic questions. RESULTS A total of 441 mother-child pairs was obtained. Children's mean age was 9.1±2.7 years, with 249 (56.5%) female. Mothers' mean age was 35.7±6.1 years. Isolated constipation was present at 35 (7.9%) children and 74 (16.8%) mothers. Isolated lower urinary tract symptoms were present in 139 (31.5%) children and 92 (20.9%) mothers and bladder bowel dysfunction occurred in 51 (11.6%) children and 78 (17.7%) mothers. There wasn't any association between isolated lower urinary tract symptoms in children and isolated lower urinary tract symptoms in mothers (P=0.31). In univariate analysis there were an association between bladder bowel dysfunction in children and bladder bowel dysfunction in mothers (OR=4.8 IC 95% 2.6-9.6, P<0.001) and isolated constipation in children and isolated constipation in mothers (OR=3.0 IC 95% 1.4-6.4, P=0.003). In multivariate analysis mothers with bladder bowel dysfunction was the only independent factor associated with bladder bowel dysfunction in children (OR=5.4 IC 95% 2.5-11.6, P<0.001). CONCLUSION Mothers with bladder bowel dysfunction are more likely to have a child with bladder bowel dysfunction. Association between these two dysfunctions plays an important role in this familiar presentation.
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Affiliation(s)
- Rebeca Sadigursky Ribeiro
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Glícia Estevam de Abreu
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Eneida Regis Dourado
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Maria Luiza Veiga
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Victoria Andrade Lobo
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Ubirajara Barroso
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
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18
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El-Sonbaty MM, Fathy A, Aljohani A, Fathy A. Assessment of Behavioural Disorders in Children with Functional Constipation. Open Access Maced J Med Sci 2019; 7:4019-4022. [PMID: 32165945 PMCID: PMC7061370 DOI: 10.3889/oamjms.2019.677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Functional constipation (FC) is a common health problem in paediatrics that causes significant physical and emotional distress to patients and their families. AIM In the current work, we assessed the presence of behavioural problems in children with functional constipation and their pattern and relation to various demographic and disease-associated factors. METHODS A cross-sectional case-control study was conducted, including 55 consecutive children aged 4-16 years diagnosed with functional constipation and 55 healthy age and sex-matched controls. Psychological assessment was done using the Pediatric Symptom Checklist - 17 (PSC-17). RESULTS Twenty-six (47.3%) patients with FC had positive total PSC-17 scores while none of the controls had positive scores (p-value < 0.001). Positive internalising and externalising behaviours scores and attention problems were found in 36 (65.5%), 15 (27.3%) and 12 (21.8%) of the patients respectively in contrary to controls where only 6 (10.9%) had positive scores in internalising behaviour, and non-showed externalising behaviour and 4 (7.3%) were inattentive. Older age, longer duration of illness, residency in rural areas and presence of encopresis were found to have a significant association with the presence of such problems. CONCLUSION Children with FC have more behavioural disorders compared to healthy controls. Integration of psychosocial aspects and their management is recommended during dealing with patients with FC.
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Affiliation(s)
- Marwa M. El-Sonbaty
- Child Health Department, Medical Research Division, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Ahmed Fathy
- Child Health Department, Medical Research Division, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Amal Aljohani
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Abeer Fathy
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Saudi Arabia
- Department of Pediatrics, College of Medicine, Mansoura University, Mansoura, Egypt
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19
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Yamada M, Sekine M, Tatsuse T. Psychological Stress, Family Environment, and Constipation in Japanese Children: The Toyama Birth Cohort Study. J Epidemiol 2019; 29:220-226. [PMID: 30146529 PMCID: PMC6522390 DOI: 10.2188/jea.je20180016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Childhood constipation is prevalent and negatively affects quality of life. Although psychological stress and family environment have been identified as risk factors, few epidemiological studies have examined this issue. We aimed to clarify associations of psychological stress and family environment with childhood constipation in a large-scale epidemiological study. METHODS In total, 7,998 children aged 9-10 years from the Toyama Birth Cohort Study completed questionnaires. Constipation was defined as bowel movements "less frequently than once every 2 days". Children's lifestyles, including food frequency, psychological stress, family environment, frequency of irritability, unwillingness to attend school, and frequency of interaction with their parents, were analyzed via multivariate logistic regression analysis. Parental employment status and presence at dinner were also examined. RESULTS In total, 312 children (3.9%) experienced constipation. Girls were more likely to experience constipation than boys (5.1% vs 2.8%). In addition, constipation was significantly associated with girl (odds ratio [OR] 1.97; 95% confidence interval [CI], 1.55-2.51), physical inactivity (OR 1.41; 95% CI, 1.01-1.95), overweight (OR 0.58; 95% CI, 0.40-0.85), infrequent fruit (OR 1.94; 95% CI, 1.42-2.66) and vegetable (OR 1.46; 95% CI, 1.03-2.05) consumption, frequent irritability (OR 1.76; 95% CI, 1.24-2.50), unwillingness to attend school (OR 1.66; 95% CI, 1.13-2.43), and infrequent interaction with parents (OR 1.48; 95% CI, 1.06-2.07). Children whose parents were absent at dinner were more likely to experience constipation compared to those whose parents were present at dinner; however, this differences were not statistically significant. CONCLUSION Psychological stress and infrequent interaction with parents were as strongly associated with childhood constipation as conventional risk factors. Psychological stress and family environment should be more prioritized in caring childhood constipation.
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Affiliation(s)
- Masaaki Yamada
- Department of Epidemiology and Health Policy, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Takashi Tatsuse
- Department of Epidemiology and Health Policy, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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20
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Wu XD. Progress in research of functional constipation in children. Shijie Huaren Xiaohua Zazhi 2017; 25:2950-2955. [DOI: 10.11569/wcjd.v25.i33.2950] [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] [Indexed: 02/06/2023] Open
Abstract
Constipation is a common symptom in the children population, which can be a manifestation of organic diseases or may be caused by functional factors. More than 90% of cases of constipation in children are functional constipation (FC). As a physical and mental illness in childhood or even a public health problem, FC has multidimensional impacts on children and their families, posing a great healthcare burden on the society. The Rome Ⅳ criteria for diagnosis of functional gastrointestinal disorders were published in 2016, in which a global consensus was formed and modified for the diagnostic criteria of FC in children. However, there are still difficulties in the choice of FC treatments and assessment of its outcome not only because of the distinct understanding and application of the criteria but also because of the incomplete understanding of the pathogenesis of FC. Therefore, the pathophysiological mechanism of FC and its therapeutic efficacy evaluation should be further studied in the future.
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Affiliation(s)
- Xue-Dong Wu
- Department of Pediatric Surgery, the First Affiliated Hospital and Clinical Medical Research Center of Dali University, Dali 671000, Yunnan Province, China
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21
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Joda AE, Al-Mayoof AF. Efficacy of nitroglycerine ointment in the treatment of pediatric anal fissure. J Pediatr Surg 2017; 52:1782-1786. [PMID: 28410787 DOI: 10.1016/j.jpedsurg.2017.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/26/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anal fissure is the most common anal disease in children. In the past few decades, the understanding of its pathophysiology has led to a progressive reduction in invasive procedures in favor of conservative treatment based on stool softeners and the relaxation of the anal sphincter. This randomized controlled study assessed the safety and efficacy of nitroglycerine (NTG) ointment in the treatment of pediatric anal fissure, which had not yet been proved. PATIENTS AND METHODS An unequal randomized controlled study included 105 pediatric patients with anal fissure who had presented to the private and outpatient clinics of the Central Teaching Hospital of Pediatrics during the period from February 2015 to May 2016. The control group consisted of 70 patients. Both groups were treated with classical conservative therapy of sitz bath, stool softener, and local anesthetic. In the second group, chemical sphincterotomy with 0.2% NTG ointment was used in 35 patients, and was applied at the anal canal twice daily for 8weeks. The primary outcomes of symptomatic improvement and healed fissure, as well as side effects, were analyzed. RESULTS The average age of patients was 2years (range, 4months to 5years). Patients in the NTG group had 77% symptomatic relief and 60% healed fissure compared to the control group, which had 54% and 32.8% respectively. All were statistically significant. No serious adverse effects were noticed during the treatment period. CONCLUSION The use of 0.2% NTG ointment is an effective therapy for anal fissure in children in terms of good healing rate and rapid symptom relief, but it has the drawback of a long treatment period, making patient compliance more difficult, in addition to the problems of tolerance and recurrence. TYPE OF STUDY Prospective randomized controlled study (treatment study). LEVEL OF EVIDENCE Type 2.
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Affiliation(s)
- Ali E Joda
- Surgery Department, College of Medicine, Al-Mustansiriyah University; Department of Pediatric Surgery, Central Teaching Hospital of Pediatrics, Hay Almothana 19100, Zayouna, Baghdad, Iraq.
| | - Ali F Al-Mayoof
- Surgery Department, College of Medicine, Al-Mustansiriyah University; Department of Pediatric Surgery, Central Teaching Hospital of Pediatrics, Hay Almothana 19100, Zayouna, Baghdad, Iraq.
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Elkhayat H, Shehata M, Nada A, Deifalla S, Ammar M. Impact of functional constipation on psychosocial functioning and quality of life of children: A cross sectional study. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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