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No role for increased rectal compliance in pediatric functional constipation.

Maartje M van den Berg1, Marloes E J Bongers, Wieger P Voskuijl

  • 1Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands. maartjemvdberg@gmail.com

Gastroenterology
|August 25, 2009
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Summary

Severely increased rectal compliance in pediatric functional constipation is linked to worse symptoms but not treatment failure. Enemas do not improve rectal compliance in children with constipation.

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Area of Science:

  • Pediatric Gastroenterology
  • Bowel Motility Disorders
  • Functional Gastrointestinal Disorders

Background:

  • Increased rectal compliance is a proposed factor in pediatric functional constipation (FC).
  • The clinical significance of elevated rectal compliance and the impact of enemas on it remain unclear.

Purpose of the Study:

  • To evaluate the clinical relevance of increased rectal compliance in pediatric FC.
  • To determine if regular enema use improves rectal compliance in children with FC.

Main Methods:

  • A prospective longitudinal study involving 101 children (8-18 years) with FC.
  • Rectal compliance was measured using pressure-controlled rectal distensions at baseline and 1 year.
  • Patients received either conventional therapy or conventional therapy plus rectal enemas.

Main Results:

  • At baseline, 24% of children had severely increased rectal compliance, associated with lower defecation frequency, more fecal incontinence, and impaction.
  • After 1 year, treatment success rates were similar across compliance groups (40-42%).
  • Rectal compliance did not change in either treatment group, and enema use did not improve compliance.

Conclusions:

  • Severely increased rectal compliance in pediatric FC correlates with symptom severity but not treatment outcomes.
  • Current evidence suggests that regular enema use does not improve rectal compliance in pediatric functional constipation.