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Disorders of defecation in children: evaluation and management
Insights
Constipation and fecal incontinence affect many children, often linked to physical findings like stool in the bowel. Early diagnosis and a patient-centered treatment approach are key for managing these defecation disorders.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Disorders of defecation are common in children.
- Constipation is the predominant issue, often co-occurring with fecal incontinence.
Purpose of the Study:
- To analyze the clinical presentation, diagnostic methods, and treatment outcomes for pediatric defecation disorders.
- To evaluate the efficacy of diagnostic tools like rectal biopsy and anorectal manometry.
Main Methods:
- Retrospective analysis of 123 children with defecation disorders.
- Physical examination, laboratory tests, radiologic imaging, rectal suction biopsy, and anorectal manometry were employed.
- Treatment involved non-cathartic laxatives, physician-family communication, and psychological support.
Main Results:
- Constipation was diagnosed in 89 children, and fecal incontinence in 34; most with incontinence also had constipation.
- Physical findings included abdominal distension and palpable rectal stool.
- Rectal suction biopsy was diagnostic for Hirschsprung's disease in all affected patients; anorectal manometry showed limited value.
Conclusions:
- Pediatric defecation disorders require a comprehensive approach combining medical management and psychosocial support.
- A patient, empathetic physician is crucial for successful treatment outcomes.
- Rectal biopsy is a reliable diagnostic tool for Hirschsprung's disease in this population.
Abstract:
In a series of 123 children with disorders of defecation, constipation was the main problem in 89 and fecal incontinence in 34. All but three of the latter also had constipation. The principal physical findings were abdominal protuberance with palpable stool in the bowel and the presence of a fecal mass in the rectal ampulla. Laboratory and radiologic findings were nonspecific except in two of the three patients found to have congenital megacolon (Hirschsprung's disease). Rectal suction biopsy, performed in 69 patients, was diagnostic in all three with Hirschsprung's disease. Anorectal manometry, done in 11 patients, was of limited value. In general, treatment consists of patience and understanding on the part of physician and family, a regimen of orally administered (noncathartic) laxatives with dose gradually reduced over weeks to months, frequent telephone communication between physician and parents, and occasional office visits. Patients with nonretentive fecal incontinence require an intensive psychologic approach. A patient, empathetic, and available physician is one of the most important ingredients in the treatment regimen.
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