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Persistence of chronic constipation in children after biofeedback treatment
1Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242.
Insights
Biofeedback therapy for chronic constipation in children showed mixed results. While some children learned to relax their pelvic floor, recovery rates varied, suggesting other anorectal factors influence treatment success.
Area of Science:
- Pediatric Gastroenterology
- Biofeedback Therapy
- Anorectal Disorders
Background:
- Chronic constipation and encopresis are common in children.
- Abnormal pelvic floor muscle contraction during straining can impede treatment.
- Conventional therapies may fail in some pediatric cases.
Purpose of the Study:
- To assess biofeedback efficacy in children with chronic constipation and pelvic floor dysfunction.
- To identify anorectal factors contributing to persistent constipation despite biofeedback.
- To explore the role of psychological factors in treatment outcomes.
Main Methods:
- A cohort of 38 children with chronic constipation and pelvic floor dysfunction received biofeedback therapy.
- Anorectal manometry was used to assess pelvic floor relaxation and rectal/anal responsiveness.
- Psychological assessments evaluated social competence and behavior problems.
Main Results:
- Twenty-eight children achieved pelvic floor relaxation with biofeedback; 14 recovered, 14 did not.
- Nine children failed to learn pelvic floor relaxation; one had recurrence.
- Nonrecovered patients exhibited reduced rectal and anal sensitivity to distension compared to recovered patients.
Conclusions:
- Biofeedback can improve pelvic floor function in children with chronic constipation.
- Persistent constipation despite successful pelvic floor relaxation may relate to altered anorectal sensitivity.
- Psychological factors did not significantly influence recovery from chronic constipation and encopresis in this cohort.
Abstract:
We investigated the efficacy of biofeedback treatment and evaluated anorectal factors that might be responsible for persistence of chronic constipation with or without encopresis in a group of 38 children with abnormal contraction of the pelvic floor during straining and persistence of chronic constipation with encopresis after conventional treatment. Nine children were unsuccessful in learning to relax the pelvic floor during straining with biofeedback treatment, and one patient had contraction of the pelvic floor on follow-up despite successful biofeedback treatment; none recovered. Twenty-eight children were able to relax the pelvic floor on follow-up; 14 recovered and 14 did not recover from chronic constipation. Nonrecovered patients who learned to relax the pelvic floor had significantly decreased rectal and anal responsiveness to rectal distension as compared to recovered patients during the initial and follow-up anorectal manometric study. Psychological factors such as social competence and behavior problems did not appear to be responsible for recovery or nonrecovery from chronic constipation and encopresis.