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Balloon defecation as a predictor of outcome in children with functional constipation and encopresis
1Department of Pediatrics, University of Iowa, Iowa City, USA.
Insights
The ability to pass a rectal balloon in children with constipation and encopresis was linked to a higher recovery rate. However, this balloon defecation test is not a reliable predictor of recovery.
Area of Science:
- Pediatric Gastroenterology
- Bowel Dysfunction Research
- Clinical Predictors of Recovery
Background:
- Functional constipation and encopresis are common in children.
- Predicting treatment outcomes in these children is crucial for effective management.
Purpose of the Study:
- To determine if the ability to defecate a rectal balloon can predict 12-month recovery in children with functional constipation and encopresis.
Main Methods:
- A balloon defecation test (100 ml water-filled rectal balloon, 5-minute defecation time) was administered to 20 healthy children and 139 children with functional constipation and encopresis.
- Recovery was assessed at 12 months.
Main Results:
- Only 47% of patients could defecate the balloon, compared to all healthy children.
- Patients able to defecate the balloon had a 51% recovery rate versus 34% for those unable to (p < 0.03).
- The balloon defecation test showed moderate sensitivity (57%) and specificity (60%) for predicting recovery.
Conclusions:
- Children with functional constipation and encopresis who could pass a rectal balloon were twice as likely to recover.
- Despite a significant difference in recovery rates, the balloon defecation test's predictive values indicate it cannot reliably predict recovery.
Objective:
To evaluate whether the ability to defecate a rectal balloon might predict 12-month recovery in children with functional constipation and encopresis.
Methods:
We evaluated the ability to defecate within 5 minutes a 100 ml waterfilled rectal balloon by 20 healthy children and 139 children with functional constipation and encopresis.
Results:
All healthy children and only 47% of the patients were able to defecate the balloon. Twelve months after the start of treatment, 51% of patients able to and 34% of patients unable to defecate the balloon had recovered (p < 0.03). Logistic regression revealed that the ability to defecate the balloon and a history of secondary encopresis were related to recovery (p < 0.04). Patients who were unable to defecate the balloon or who did not recover had significantly more impairment in anorectal functions than those who were able to defecate the balloon or who did recover. The ability of the balloon defecation test to predict recovery had a sensitivity of 57%, a specificity of 60%, a positive predictive value of 0.51, and a negative predictive value of 0.66.
Conclusion:
Children with functional constipation and encopresis who were able to defecate the rectal balloon were twice as likely to recover. Even though there was a clinically significant difference in the recovery rates between patients who could and those who could not defecate the balloon, calculation of predictive values showed that the balloon defecation test could not reliably predict recovery.