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Defecation problems in children with Hirschsprung's disease: a biopsychosocial approach
E M van Kuyk1, A T Brugman-Boezeman, M Wissink-Essink
1Department of Medical Psychology, University Hospital Nijmegen, The Netherlands.
Insights
This study shows a multidisciplinary treatment significantly improves bowel problems in children with operated Hirschsprung
Area of Science:
- Pediatric Surgery
- Developmental Psychology
- Gastroenterology
Background:
- Hirschsprung's disease (HD) surgery often leads to postoperative defecation issues in school-aged children.
- These chronic bowel problems negatively impact psychosocial development and quality of life.
- Early intervention is crucial for managing these persistent issues.
Purpose of the Study:
- To evaluate a novel multidisciplinary treatment for postoperative defecation problems in Hirschsprung's disease.
- To assess the efficacy of a biopsychosocial approach in improving bowel self-control and toilet behavior.
Main Methods:
- A retrospective study of 16 boys with operated Hirschsprung's disease.
- A five-step multidisciplinary treatment program involving a child psychologist, pediatric physiotherapist, and pediatric surgeon.
- Focus on teaching bowel self-control, optimal defecation skills, and appropriate toilet behavior.
Main Results:
- Significant improvements were observed in all aspects of defecation problems during the treatment.
- The treatment demonstrated effectiveness across different age groups (2-14 years).
- Multidisciplinary intervention successfully reduced chronic bowel issues post-surgery.
Conclusions:
- Multidisciplinary treatment is effective in resolving postoperative chronic bowel problems in children with Hirschsprung's disease.
- The biopsychosocial approach offers a promising strategy for improving long-term outcomes.
- Early and comprehensive management can enhance the quality of life for affected children.
Abstract:
Although most patients with operated Hirschsprung's disease (HD) have good continence in adulthood, a majority have postoperative defection problems during school age. Persistence of chronic constipation and/or incontinence may have considerable consequences for psychosocial development, parent-child interactions, quality of life, and the child's general condition. Considering these consequences, it is important to treat these problems as early as possible. From a biopsychosocial view, we developed a multidisciplinary treatment aimed at resolving defecation problems by teaching the child bowel self-control, primarily by training optimal defecation skills and subsequently toilet behavior. This treatment, carried out by a child psychologist, a pediatric physiotherapist, and a pediatric surgeon, consists of five steps: explanation; extinction of fear and avoidance behavior; learning new defecation behavior; learning an adequate straining technique; and generalization toward daily life. The effect of the treatment was investigated retrospectively in 16 boys with operated HD. The children improved significantly in all aspects during treatment, suggesting that multidisciplinary treatment can significantly reduce the postoperative chronic bowel problems of most children with operated HD. The treatment was as effective in young children (2-5 years) as in older children (5-14 years).