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Effectiveness of Pelvic Physiotherapy in Children With Functional Constipation Compared With Standard Medical Care
Marieke L van Engelenburg-van Lonkhuyzen1, Esther M J Bols1, Marc A Benninga2
1Department of Epidemiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
Insights
Pelvic physiotherapy (PPT) significantly improved functional constipation (FC) outcomes in children compared to standard medical care (SMC). PPT led to higher success rates and reduced laxative use, offering a promising treatment option for childhood FC.
Area of Science:
- Pediatric Gastroenterology
- Physical Therapy
- Child Health
Background:
- Functional constipation (FC) is a prevalent pediatric condition frequently linked to pelvic floor muscle dysfunction.
- Pelvic floor muscle dysfunction is a common contributing factor in childhood functional constipation.
Purpose of the Study:
- To compare the efficacy of pelvic physiotherapy (PPT) against standard medical care (SMC) for treating functional constipation in children.
- To evaluate PPT as a treatment for pediatric functional constipation.
Main Methods:
- A multicenter randomized controlled trial involving 53 children (aged 5-16 years) diagnosed with FC.
- Children received either SMC (education, toilet training, laxatives) or PPT (SMC plus specific physiotherapy interventions).
- Outcomes included absence of FC, perceived treatment effect, quality of life, and the Strengths and Difficulties Questionnaire (SDQ) after a 6-month follow-up.
Main Results:
- Pelvic physiotherapy (PPT) demonstrated significantly higher treatment effectiveness (92.3%) compared to standard medical care (SMC) (63.0%).
- Children in the PPT group were more likely to discontinue laxative use and reported higher global perceived effect scores.
- PPT also led to significant improvements in quality of life scores for both parents and children.
Conclusions:
- Pelvic physiotherapy (PPT) is more effective than standard medical care (SMC) for treating functional constipation in children aged 5-16 years, based on multiple outcome measures.
- PPT should be considered a valuable treatment option for pediatric functional constipation.
Background & Aims:
Functional constipation (FC) is a common childhood problem often related to pelvic floor muscle dysfunction. We compared the effectiveness of pelvic physiotherapy (PPT) vs standard medical care (SMC) in children with FC.
Methods:
We performed a multicenter randomized controlled trial of 53 children (age, 5-16 y) with FC according to the Rome III criteria, at hospitals in The Netherlands from December 2009 to May 2014. Group allocation was concealed using a central computer system. SMC consisted of education, toilet training, and laxatives (n = 26), whereas PPT included SMC plus specific physiotherapeutic interventions (n = 27). Results were obtained from written reports from the subjects' pediatricians and parents. The primary outcome was absence of FC, according to Rome III criteria, after a 6-month follow-up period. Secondary outcomes were global perceived effect (range, 1-9; success was defined as a score ≥ 8), numeric rating scales assessing quality of life (parent and child; scale, 1-10), and the strengths and difficulties questionnaire (SDQ).
Results:
Treatment was effective for 92.3% of the children receiving PPT and for 63.0% of the children receiving SMC (adjusted odds ratio for success of PPT, 11.7; 95% confidence interval, 1.8-78.3) (P = .011). Significantly more children undergoing PPT stopped using laxatives (adjusted odds ratio, 6.5; 95% confidence interval, 1.6-26.4) (P = .009). Treatment success (based on global perceived effect) was achieved for 88.5% of subjects receiving PPT vs 33.3% of subjects receiving SMC) (P < .001). PPT also produced larger adjusted mean differences, before vs after treatment, in numeric rating scales to assess quality of life: an increase of 1.8 points for parents (P = .047) and 2.0 points for children (P = .028). Results from the SDQ did not differ significantly between groups (P = .78).
Conclusions:
In a randomized controlled trial of children with FC, PPT was more effective than SMC on all outcomes measured, with the exception of findings from the SDQ. PPT should be considered as a treatment option for FC in children 5-16 years old. Dutch Clinical Trial Registration no: NL30551.068.09.
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