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Longitudinal follow-up of children with functional nonretentive fecal incontinence
Wieger P Voskuijl1, Johannes B Reitsma, Rijk van Ginkel
1Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam, the Netherlands. w.p.voskuijl@amc.nl
Insights
Functional nonretentive fecal incontinence (FNRFI) treatment shows slow progress, with only 29.5% success after two years. Many children experience improvement beyond puberty, but 15% still have FNRFI at age 18.
Area of Science:
- Pediatric Gastroenterology
- Childhood Functional Disorders
Background:
- Functional nonretentive fecal incontinence (FNRFI) is a common childhood issue with limited long-term outcome data.
- Understanding the long-term prognosis of FNRFI is crucial for effective management strategies.
Purpose of the Study:
- To investigate the long-term outcomes of children diagnosed with FNRFI.
- To evaluate the effectiveness of intensive medical treatment, including biofeedback and laxatives, over an extended period.
Main Methods:
- 119 children with FNRFI were enrolled in two prospective, randomized trials from 1990-1999.
- Treatment involved biofeedback and/or laxatives, with follow-up conducted annually for up to 14 years.
- Success was defined as less than one fecal incontinence episode per two weeks.
Main Results:
- After two years of intensive therapy, 29.5% of patients achieved success.
- Cumulative success reached 80% after seven years of follow-up.
- At age 18, 15.5% of patients still experienced fecal incontinence, with 37% experiencing relapse.
Conclusions:
- Intensive medical treatment for FNRFI yields modest success rates in the short term (29.5% after 2 years).
- While many patients improve after puberty, a significant minority (15.5% at age 18) continue to struggle with fecal incontinence.
- Long-term follow-up is essential to understand the full trajectory of FNRFI and treatment effectiveness.
Background & Aims:
Functional nonretentive fecal incontinence (FNRFI), incontinence in the absence of signs of fecal retention, is a frustrating phenomenon in children. No data on long-term outcome are available. The aim was to investigate the long-term outcome of FNRFI patients after intensive medical treatment.
Methods:
Between 1990 and 1999, 119 patients (96 boys) with FNRFI were enrolled in 2 prospective, randomized trials investigating the effect of biofeedback training and/or laxative treatment. Follow-up (FU) was performed at 6 months, 1 year, and thereafter annually until September 2004. A standardized questionnaire was used to evaluate symptoms. Success was defined as a fecal incontinence frequency <1 per 2 weeks.
Results:
Median age (25th-75th percentiles) was 9.2 years (range, 7.9-11.6 years). A 90% FU was achieved at all stages of the study. After 2 years of intensive therapy, 33 of 112 (29.5%) patients were successfully treated. The cumulative success percentage after 7 years of FU was 80%. At the biologic ages of 12 and 18 years, 49.4% (40/81) and 15.5% (9/58), respectively, of the patients still had fecal incontinence. Duration of fecal incontinence, with 4 years of age as the starting age for fecal incontinence (when a child should be toilet trained), was not related to successful outcome or relapse. Relapse occurred in 37% of patients.
Conclusions:
Only 29% of the patients with FNRFI were successfully treated after 2 years of intensive treatment. Despite recovery in the majority of patients beyond puberty, at age 18 years, 15% continued to have fecal incontinence.
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