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Treatment of childhood encopresis: a randomized trial comparing three treatment protocols
Stephen M Borowitz1, Daniel J Cox, James L Sutphen
1Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908, USA. Witz@virginia.edu
Insights
Enhanced toilet training (ETT) shows greater effectiveness in treating childhood encopresis compared to intensive medical therapy (IMT) alone or with biofeedback (BF). ETT significantly reduces soiling frequency, offering a promising approach for managing this condition.
Area of Science:
- Pediatric Gastroenterology
- Behavioral Therapy
- Childhood Functional Disorders
Background:
- Chronic encopresis affects children, causing significant distress and impacting quality of life.
- Various treatment protocols exist, but comparative effectiveness, especially long-term, requires further investigation.
Purpose of the Study:
- To compare the short- and long-term effectiveness of three additive treatment protocols for chronic encopresis in children.
- To evaluate intensive medical therapy (IMT), IMT with enhanced toilet training (ETT), and IMT with ETT and biofeedback (BF).
Main Methods:
- Children aged 6-15 with at least weekly fecal soiling for 6+ months were randomized into IMT, ETT, or BF groups.
- Daily toileting data were collected via a computerized voice-mail system for 14 days pre-treatment and at 3, 6, and 12 months.
- Outcomes assessed included cure rates (no accidents in 2 weeks) and significant improvement (reduced soiling).
Main Results:
- While overall cure rates at 12 months were similar across groups (36% IMT, 48% ETT, 39% BF), improvement rates varied significantly (45% IMT, 78% ETT, 54% BF).
- The enhanced toilet training (ETT) group demonstrated statistically significant higher improvement rates (P < 0.05) and reduced laxative use.
- Early response to treatment within the first two weeks strongly predicted long-term outcomes (P < 0.0001).
Conclusions:
- Enhanced toilet training (ETT) is more effective than intensive medical therapy (IMT) or IMT with biofeedback (BF) for improving childhood encopresis.
- While cure rates are comparable, ETT leads to a statistically significant greater reduction in the daily frequency of soiling.
- Early treatment response is a key indicator of successful long-term management for childhood encopresis.
Objectives:
To compare short- and long-term effectiveness of three additive treatment protocols in children experiencing chronic encopresis.
Methods:
Children, 6 to 15 years of age, who experienced at least weekly fecal soiling for 6 months or longer were eligible for the study. Children were randomly assigned to a group that received intensive medical therapy (IMT), a group that received intensive medical therapy plus a behavior management program called enhanced toilet training (ETT), or a group that received intensive medical therapy with enhanced toilet training and external anal sphincter electromyographic biofeedback (BF). Data concerning toileting habits were collected for 14 consecutive days before an initial visit, and at 3, 6, and 12 months after initiation of therapy. All data were collected using a computerized voice-mail system that telephoned the families each day. At 12 months, children were classified as significantly improved (reduction in soiling, P < 0.001) or cured (
Results:
Eighty-seven children participated in the study, 72 boys and 15 girls. Mean age at enrollment was 8.6 +/- 2.0 years, and mean duration of symptoms was 58.2 +/- 38.5 months. At 12 months, the cure rates for the IMM, ETT, and BF groups were 36, 48, and 39, respectively (not significant). The improvement rates for these three groups were 45, 78, and 54, respectively (P < 0.05). These results were very stable over time (r > 0.90, P < 0.001 in each case). Response to treatment during the first 2 weeks of therapy was highly predictive of outcome at 3, 6, and 12 months (P < 0.0001). Children in the ETT group used less laxative medication (P < 0.04) and required fewer treatment contacts (P = 0.08) than children in the IMM group. All three treatments resulted in significant increases in daily bowel movements passed in the toilet and self-initiated toileting, and resulted in decreases in average daily soiling at 3, 6, and 12 months (P < 0.05).
Conclusions:
Enhanced toilet training is somewhat more effective in treating childhood encopresis than either intensive medical therapy or anal sphincter biofeedback therapy. Although similar total cure rates at 1 year can be expected with these three forms of therapy, enhanced toilet training results in statistically significant decreases in the daily frequency of soiling for the greatest number of children.