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[Painful defecation and chronic functional constipation in children: Diagnosis and treatment]
M D Sabatino1, M Borrelli, P Cautiero
1Dipartimento di Chirurgia Pediatrica , Seconda Università degli Studi di Napoli, Napoli, Italy.
Insights
This study shows that a multimodal treatment approach, including dietary changes and local analgesics, effectively treats chronic constipation with painful defecation in children. Botulinum toxin A is a viable alternative for resistant cases.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Chronic constipation with painful defecation is a common pediatric issue.
- The condition can lead to a cycle of spasm and pain, impacting quality of life.
Purpose of the Study:
- To evaluate a comprehensive treatment strategy for chronic constipation associated with defecation pain in pediatric patients.
- To assess the efficacy of botulinum toxin A and surgical intervention for refractory cases.
Main Methods:
- Sixty pediatric patients (6 months–12 years) meeting ROMA II criteria were enrolled.
- Treatment included a defecation retraining program, high-fiber diet, lactulose, and local prilocaine/lidocaine.
- Refractory cases with internal anal sphincter thickening received botulinum toxin A injections; two underwent sphincterectomy.
Main Results:
- 71.4% of patients achieved daily, pain-free bowel movements post-treatment.
- Nine patients experienced symptom relapse.
- Two patients treated with sphincterectomy showed normalized anal function within 6 weeks.
Conclusions:
- The proposed treatment strategy effectively breaks the spasm-pain cycle in pediatric chronic constipation.
- Botulinum toxin A offers a valuable, less invasive alternative to surgery for selected treatment-resistant patients with thickened internal anal sphincters.
Aim:
The aim of this study was to report our results on the treatment of chronic constipation associated with pain during defecation.
Methods:
From January 1999 to January 2004, 60 patients (25 females, 35 males; age range, 6 months to 12 years) who met the ROMA II diagnostic criteria for chronic functional constipation associated with pain on defecation were enrolled in the study. All subjects underwent anorectal manometry to determine rectosphincter inhibitory reflex function. A retraining program for daily defecation, a diet high in fiber and lactulose, and local administration of prilocaine/lidocaine were instituted. At rectal anal endosonography, 7 drug-treatment-resistant patients presented with increased thickness of the internal anal sphincter and received botulin toxin A injection at the sphincter. Because symptoms persisted in 2 of these patients, they received a sphincterectomy.
Results:
At the end of treatment, 40 (71.4%) of the 56 patients who completed the study had a daily bowel movement without pain; 9 experienced a relapse; in the 2 surgical patients the alveus returned to normal function at 2 and 6 weeks, respectively.
Conclusions:
Our treatment strategy breaks the vicious circle of spasm-pain-spasm with use of prolonged analgesic treatment and feces softener over the course of the day. In treatment-resistant patients with functioning rectosphincter reflexes and thickened internal anal sphincter, administration of botulin toxin A may be a valuable aid in place of standard sphincterectomy.
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