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Biopsychosocial treatment of defecation problems in children with anal atresia: a retrospective study
E M van Kuyk1, A T Brugman-Boezeman, M Wissink-Essink
1Department of Medical Psychology, University Hospital Nijmegen, The Netherlands.
Insights
Multidisciplinary treatment combining medical care and behavioral programs significantly improves defecation issues like incontinence and constipation in children with operated anal atresia (AA). This approach is effective across all age groups, including young children aged 2-5 years.
Area of Science:
- Pediatric Surgery
- Pediatric Gastroenterology
- Child Psychology
Background:
- Children with operated anal atresia (AA) often experience persistent defecation problems, including incontinence and constipation.
- A biopsychosocial approach is crucial for addressing complex pediatric conditions.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary treatment in reducing defecation problems in children with operated AA.
- To assess treatment efficacy in young children (2-5 years) specifically.
Main Methods:
- Retrospective study of 43 children (aged 2-16 years) with operated AA.
- Treatment involved a pediatric surgeon, child psychologist, and pediatric physiotherapist, integrating standard medical care with a behavioral program.
- Evaluated continence, constipation, defecation behavior, and straining techniques.
Main Results:
- Significant improvements were observed in all evaluated aspects of defecation following the multidisciplinary treatment.
- The treatment demonstrated equal effectiveness in young children (2-5 years) and older children.
- Both somatic and behavioral factors were identified as contributors to chronic defecation problems.
Conclusions:
- Multidisciplinary treatment incorporating behavioral modification is effective for managing defecation problems in children with operated AA.
- The biopsychosocial approach is essential for addressing the persistent defecation issues in this pediatric population.
Abstract:
In a retrospective study, we examined whether multidisciplinary treatment based on a biopsychosocial approach and carried out by a pediatric surgeon, a child psychologist, and a pediatric physiotherapist is successful in reducing defecation problems (incontinence and/or constipation) in children with operated anal atresia (AA) (mean age 6.9 +/- 4.01 years). A second question was whether this treatment is successful in young children aged 2-5 years. The multidisciplinary approach consisted of standard medical treatment and a behavioral program to teach children and their parents adequate defecation behavior including an adequate straining technique. Forty-three children aged 2-16 years were included: 27 boys and 16 girls with AA, of whom 26 had high or intermediate and 17 low AA. Besides continence and constipation, defecation behavior and straining technique were evaluated. The children improved significantly during treatment in all aspects of defecation. No differences in effect of treatment were found between young children (2-5 years) and older ones, so this treatment seems to be equally effective in both age groups. This study demonstrates that both somatic and behavioral factors contribute to the persistence of chronic defecation problems. It is concluded that treatment of these problems in patients with operated AA should include behavioral modification techniques.
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