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Group Treatment of Fecal Incontinence: A Description of an Interdisciplinary Intervention
Kelsey Gonring1, Bridget Dolan1, Theresa L Kapke1
1Marquette University.
Insights
This study shows that an interdisciplinary, group-based treatment called "Poop group" effectively improves stooling and reduces soiling in children with chronic fecal incontinence. Medication adherence also increased, with results maintained at follow-up.
Area of Science:
- Pediatric Gastroenterology
- Behavioral Health
- Interdisciplinary Care
Background:
- Chronic fecal incontinence affects approximately 5% of US children.
- Standard medical management fails in 20-60% of pediatric fecal incontinence cases.
- A combined medical-behavioral approach is often recommended for refractory cases.
Purpose of the Study:
- To describe an interdisciplinary, group-based treatment for school-aged children with fecal incontinence.
- To evaluate changes in treatment adherence and clinical effectiveness.
- To assess the impact of a novel intervention on pediatric fecal incontinence management.
Main Methods:
- A 6-week interdisciplinary protocol ('Poop group') involving separate, simultaneous therapy groups for children and caregivers.
- Focus on gastrointestinal (GI) system education, medication adherence, toilet posture, hydration, fiber intake, and behavior contracts.
- Individual consultations with an Advanced Nurse Practitioner for symptom management and medication adjustments.
Main Results:
- Nineteen families completed the protocol.
- Significant improvement in appropriate stool frequency (P ≤ 0.01) and reduction in soiling events (P ≤ 0.00).
- Improved medication adherence (P ≤ 0.04) with sustained results at 1-month follow-up.
Conclusions:
- The developmentally targeted, interdisciplinary 'Poop group' intervention demonstrates treatment success.
- This approach may be an effective option for children with fecal incontinence unresponsive to traditional outpatient treatment.
- The study highlights the potential of group-based, multidisciplinary care in pediatric functional GI disorders.
Introduction:
Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20% to 60% of cases. A combined medical-behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group-based treatment for fecal incontinence in school-aged children, and to present a description of changes in treatment adherence rates that affect clinical effectiveness.
Method:
Poop group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6-week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre- to post-treatment. Group sessions focus on the GI system, medication, toilet sitting posture, hydration, fiber, and behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed.
Results:
Nineteen families completed the 6-week protocol. Appropriate stool frequency was improved (P ≤ 0.01), and soiling was reduced (P ≤ 0.00). Medication adherence was also improved (P ≤ 0.04). Treatment results were maintained at 1-month follow-up.
Discussion:
A developmentally targeted intervention and interdisciplinary focus of treatment likely account for treatment successes.
Conclusion:
Poop group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment.
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