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A multicenter study on childhood constipation and fecal incontinence: effects on quality of life
Katja Kovacic1, Manu R Sood1, Suzanne Mugie2
1Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
Insights
Fecal incontinence in children significantly worsens quality of life, family functioning, and psychosocial well-being compared to functional constipation alone. Early intervention is crucial for managing this prevalent condition.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Quality of Life Research
Background:
- Functional constipation is a common pediatric condition.
- Fecal incontinence in children with constipation can significantly impact daily life.
- Understanding the multifaceted effects on children and families is essential for effective management.
Purpose of the Study:
- To compare the quality of life in children with functional constipation versus those with functional constipation and fecal incontinence.
- To evaluate the effects on physical, psychosocial, and family functioning in these pediatric groups.
- To identify specific risk factors and inform clinical strategies.
Main Methods:
- Prospective, multicenter study involving 410 children (aged 2-18 years) meeting Rome III criteria for functional constipation.
- Data collected from 5 regional children's hospitals.
- Parents completed validated questionnaires assessing quality of life, family impact, disability, parental stress, and psychosocial functioning.
Main Results:
- Children with functional constipation and fecal incontinence reported significantly worse overall quality of life (PedsQL Total Score, P ≤ .03).
- This group also experienced poorer family functioning (PedsQL-Family Impact Module Total Score, P ≤ .012) and increased parental stress (PIP-F/D Total Scores, P ≤ .016).
- Older children with fecal incontinence showed a further decline in quality of life (PedsQL Total Score, P ≤ .047), while physical functioning showed no significant group differences.
Conclusions:
- Fecal incontinence exacerbates the negative impact of functional constipation on children's quality of life.
- Older children with co-occurring functional constipation and fecal incontinence are a particularly vulnerable group.
- Early identification and integrated treatment of constipation, incontinence, and associated psychosocial issues are recommended to mitigate adverse outcomes.
Objective:
To describe the effects of childhood functional constipation compared with functional constipation plus fecal incontinence on quality of life, evaluating effects on physical, psychosocial, and family functioning.
Study Design:
This prospective, multicenter study collected data from 5 regional children's hospitals. Children meeting Rome III criteria for functional constipation were included. Parents completed the following 5 instruments: Pediatric Quality of Life Inventory (PedsQL), PedsQL-Family Impact Module, Functional Disability Inventory-Parent Version, Pediatric Inventory for Parents (PIP), and Pediatric Symptom Checklist-Parent Report.
Results:
Families of 410 children aged 2-18 years (mean [SD], 7.8 [3.5] years; 52% male) were included. Children with functional constipation+fecal incontinence had worse quality of life than children with functional constipation alone (PedsQL Total Score, P ≤ .03). Older children with functional constipation + fecal incontinence had lower quality of life than their younger counterparts (PedsQL Total Score, P ≤ .047). Children with functional constipation+fecal incontinence had worse family functioning (PedsQL-Family Impact Module Total Score, P ≤ .012), greater parental stress (PIP-F Total Score, P ≤ .016; PIP-D Total Score, P ≤ .013), and poorer psychosocial functioning (Pediatric Symptom Checklist Total Score, P ≤ .003). There were no statistically significant between-group differences in physical functioning based on the functional Disability Inventory.
Conclusion:
Fecal incontinence significantly decreases quality of life compared with functional constipation alone in children. Older children with functional constipation+fecal incontinence may be at particular risk. Strategies for early identification and treatment of constipation along with diagnosis and treatment of related adjustment difficulties may mitigate the negative impact of this highly prevalent condition.
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