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[Causes, mechanisms and therapy of functional fecal incontinence in children]
A I Lönuschkin1, T W Gascheschiladse, G S Dawitaja
1Abteilung Kinderchirurgie des wissenschaftlichen Forschungsinstituts, Akademie der Medizinischen Wissenschaft, Tbilissi.
Insights
Childhood encopresis often stems from sensory perception issues, rectal control problems, or sphincter dysfunction. Effective treatment requires a comprehensive approach addressing psychoneurologic factors and utilizing electrostimulation for improved outcomes.
Area of Science:
- Pediatric Gastroenterology
- Neurogastroenterology
- Child Psychology
Context:
- Encopresis, or fecal incontinence, is a common childhood condition with multifactorial causes.
- Understanding the underlying mechanisms is crucial for effective therapeutic interventions.
- Current therapeutic strategies often involve a combination of approaches.
Purpose:
- To elucidate the primary etiological factors contributing to childhood encopresis.
- To outline the principles of a comprehensive, non-surgical therapeutic strategy for encopresis.
- To highlight the importance of diagnostic methods in tailoring encopresis treatment.
Summary:
- Approximately 50% of childhood encopresis cases are linked to impaired perception of the need for defecation.
- Disorders in rectal adaptation or the defecation reflex account for about 30%, while sphincter apparatus dysfunction contributes around 15%.
- Nonsurgical therapy necessitates a holistic approach, including psychoneurologic support, reflex conditioning, enhanced nerve conductivity, and improved sphincter tone, with transrectal and intrarectal electrostimulation playing a significant role.
Impact:
- This research emphasizes the need for differentiated therapeutic strategies based on the specific pathogenesis of encopresis.
- A comprehensive understanding and treatment plan can lead to improved outcomes for children suffering from encopresis.
- Highlights the role of electrostimulation as a key component in the non-surgical management of encopresis.
Abstract:
1. In case of encopresis in childhood about 50% are caused by disorders of perceiving the need to relieve the bowels and bowel movement, about 30% are caused by disorders of controlling the adaptation mechanism of the rectum or the defecation reflex and about 15% are caused by disorders of the sphincter apparatus. 2. A nonsurgical therapy must be a complex one. Its effect has to aim at concerning the psychoneurologic state, conalizing the reflexes, bettering the conductivity of the nerves as well as enhancing the sphincter-tonus. In addition to psychotherapy, gymnastics and sphincter-training the transrectal and intrarectal electrostimulation is of great importance. 3. To form an estimate of the mechanism of encopresis-pathogenesis many different methods are necessary and possible; these are the precondition for an effective differentiated therapy.