The treatment of functional constipation significantly increased quality of life in children aged 4-17 years

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

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.

Unusual Management of Fecal Impaction in an Adult With Functional Constipation: A Urological Adventure

A 27-year-old male with a history of functional constipation presented for ileostomy closure. He had a 12-cm impacted rectal stool ball precluding safe ileostomy takedown. He underwent multiple unsuccessful attempts at removal, including colotomy, antegrade and retrograde enemas, and manual disimpaction. The urological team suggested a novel approach using lithotripsy. A 26-French rigid nephroscope and the Olympus ShockPulse SE ultrasonic lithotripter were utilized transanally to break up the impacted stool ball. The patient was discharged the same day without complication. Ultrasonic lithotripsy is an unusual yet effective modality for prolonged fecal impaction. By employing a unique, multidisciplinary technique, operative morbidity was avoided.

Everyday life with childhood functional constipation: A qualitative phenomenological study of parents' experiences

Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life.

AIM

To explore parents´ experiences of living with a child with FC and its impact on everyday family life.

METHOD

A qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1-14 years affected by FC.

FINDINGS

Shame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame.

CONCLUSION

FC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed.

PRACTICE IMPLICATIONS

Healthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC.

Rectal measurements and their correlation with bowel habits: Evaluation by trans-abdominal ultrasound in children with functional constipation

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.

A National Study to Compare Effective Management of Constipation in Children Receiving Concurrent Versus Standard Hospice Care

Constipation is a distressing and uncomfortable symptom children experience at end of life. There is a gap in knowledge about how different approaches to hospice care delivery might improve pediatric symptom management of constipation. The purpose of this study was to evaluate the effectiveness of pediatric concurrent hospice versus standard hospice care to manage constipation. Medicaid data (2011-2013) were analyzed. Children who were younger than 21 years enrolled in hospice care and had a hospice enrollment between January 1, 2011, and December 31, 2013, were included. Instrumental variable analysis was used to test the effectiveness of concurrent versus standard hospice care. Among the 18 152 children, approximately 14% of participants were diagnosed or treated for constipation from a nonhospice provider during hospice enrollment. A higher proportion of children received nonhospice care for constipation in concurrent hospice care, compared with standard hospice (19.5% vs 13.2%), although this was not significant (β = .22, P < .05) after adjusting for covariates. The findings demonstrated that concurrent care was no more effective than standard hospice care in managing pediatric constipation. Hospice and nonhospice providers may be doing a sufficient job ordering bowel regimens before constipation becomes a serious problem for children at end of life.