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Trends in referral to a single encopresis clinic over 20 years
Laurie Fishman1, Leonard Rappaport, Alison Schonwald
1Combined Program in Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts 02115, USA. laurie.fishman@tch.harvard.edu
Insights
Children with encopresis are being referred to specialized clinics at a younger age. Invasive evaluations and psychological assessments before referral have decreased, suggesting increased pediatrician awareness of encopresis.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Clinical Pediatrics
Background:
- Encopresis, or fecal incontinence, is a common pediatric condition.
- Understanding trends in diagnosis and treatment is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze changes in the characteristics of children with encopresis over two decades.
- To compare symptoms, prior interventions, and parental attitudes in referred children.
Main Methods:
- Retrospective analysis of encopresis clinic data from a tertiary pediatric hospital.
- Utilized initial evaluation questionnaires detailing bowel habits, soiling, and treatment history.
Main Results:
- Average referral age decreased significantly over 20 years (115 to 77 months).
- Fewer children presented with soiling lasting over 3 years (63% to 12%).
- Reduced use of barium enemas and psychological evaluations prior to referral.
Conclusions:
- Children with encopresis are referred earlier to specialized clinics.
- Decreased pre-referral invasive testing suggests improved primary care recognition.
- Further research is needed to correlate these changes with treatment outcomes.
Objective:
To compare the characteristics of children with encopresis referred to a single encopresis clinic over the course of 20 years, including symptoms, previous diagnostic and therapeutic interventions, and parental attitudes.
Methods:
A retrospective study was conducted of an encopresis clinic at a tertiary care pediatric hospital. Questionnaires at initial evaluation elicited information about bowel habits, soiling, previous evaluations, previous treatments, and parental attitudes.
Results:
In 503 children with encopresis, the average age of referral dropped from 115 months during the earliest 5 years to 77 months during the most recent 5 years. Children who had soiling for >3 years before referral decreased from 63% to 12%. The use of barium enema before referral decreased from 14% to 5%, as did psychological evaluation, from 25% to 14%. Previous therapy with enemas decreased from 45% to 27%. Mineral oil use remained at approximately 50%, and 20% of children had no previous treatment. Symptoms at referral and parental attitudes did not change across the years.
Conclusions:
Children are now referred at an earlier age to our tertiary encopresis clinic. The number of invasive and psychological evaluations has decreased before referral. However, treatment by many primary care providers before the referral has not changed. These data may suggest that pediatricians have increased awareness of encopresis and greater appreciation of its primarily physical rather than psychological nature. Additional studies will be needed to determine how these factors affect outcome.