Advertisement

Multidisciplinary behavioral treatment of defecation problems: A controlled study in children with anorectal malformations

      Abstract

      Background/Purpose: The most frequent consequences of being born with an anorectal malformation (ARM) are problems with fecal continence and constipation, which can have various negative implications. In this prospective, controlled study the effect of multidisciplinary behavioral treatment dealing with these problems is evaluated. Methods: The effect of multidisciplinary behavioral treatment was studied in 24 children (15 boys, 9 girls; mean age 5.8 years). Thirteen children were allocated to the treatment condition. The 11 children allocated to the waiting list control group also were treated after a waiting period of 6 months. Children underwent follow-up after treatment. Results: Compared with a waiting list control group, the experimental treatment group scores significantly better on 2 important measures (“Templeton,” “Percentage of feces in toilet”). Although young children had poorer scores than older children before treatment, no significant differences in the favorable outcome of treatment were found between both groups after treatment. No effect of type of ARM on treatment was found either. The results of multidisciplinary behavioral treatment remain stable over a mean follow-up period of 7 months. Conclusion: Multidisciplinary behavioral treatment is an important and valuable supplement to the standard medical treatment of children born with ARM suffering from chronic defecation problems. J Pediatr Surg 36:1350-1356. Copyright © 2001 by W.B. Saunders Company.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Langemeijer RA
        • Molenaar JC
        Continence after posterior sagittal anorectoplasty.
        J Pediatr Surg. 1991; 26: 587-590
        • Diseth TH
        • Emblem R
        Somatic function, mental health, and psychosocial adjustment of adolescents with anorectal anomalies.
        J Pediatr Surg. 1996; 31: 638-643
        • Rintala R
        • Mildh L
        • Lindahl H
        Fecal continence and quality of life in adult patients with an operated low anorectal malformation.
        J Pediatr Surg. 1992; 27: 902-905
        • Rintala R
        • Mildh L
        • Lindahl H
        Fecal continence and quality of life for adult patients with an operated high or intermediate anorectal malformation.
        J Pediatr Surg. 1994; 29: 777-780
        • Hassink EA
        Anorectal malformations: Implications for patients and parents.
        in: Thesis, Katholieke Universiteit Nijmegen, 1997: 65-67
        • Vandvik IH
        • Odegaard B
        Practical and emotional aspects of soiling in children with anorectal anomalies. Possibilities for prevention and early intervention.
        Z Kinderchir. 1981; 33: 321-329
        • Hassink EA
        • Rieu PN
        • Brugman-Boezeman AT
        • et al.
        Quality of life after operatively corrected high anorectal malformation: A long-term follow-up study of patients aged 18 years and older.
        J Pediatr Surg. 1994; 29: 773-776
        • Diseth TH
        • Emblem R
        • Solbraa IB
        • et al.
        A psychosocial follow-up of ten adolescents with low anorectal malformation.
        Acta Paediatr. 1994; 83: 216-221
        • Diseth TH
        • Bjornland K
        • Novik TS
        • et al.
        Bowel function, mental health, and psychosocial function in adolescents with Hirschsprung's disease.
        Arch Dis Child. 1997; 76: 100-106
        • Benninga MA
        • Buller HA
        • Heymans HS
        • et al.
        Is encopresis always the result of constipation?.
        Arch Dis Child. 1994; 71: 186-193
        • Hassink EA
        • Brugman-Boezeman AT
        • Robbroeckx LM
        • et al.
        Parenting children with anorectal malformations: Implications and experiences.
        Pediatr Surg Int. 1998; 13: 377-383
        • Landman GB
        • Rappaport L
        • Fenton T
        • et al.
        Locus of control and self-esteem in children with encopresis.
        J Dev Behav Pediatr. 1986; 7: 111-113
        • Levine MD
        Encopresis: Its potentiation, evaluation, and alleviation.
        Pediatr Clin North Am. 1982; 29: 315-330
        • van-der-Plas RN
        • Benninga MA
        • Redekop WK
        • et al.
        Randomised trial of biofeedback training for encopresis.
        Arch Dis Child. 1996; 75: 367-374
        • van-Kuyk EM
        • Brugman-Boezeman AT
        • Wissink-Essink M
        • et al.
        A biopsychosocial treatment of defecation problems in children with anal atresia: A retrospective study.
        Pediatr Surg Int. 2000; 16: 317-321
        • van-Kuyk EM
        • Brugman-Boezeman AT
        • Wissink-Essink M
        • et al.
        Defecation problems in children with Hirschsprung's disease: A biopsychosocial approach.
        Pediatr Surg Int. 2000; 16: 312-316
        • Bleijenberg G
        • Kuijpers HC
        Biofeedback treatment of constipation: A comparison of two methods.
        Am J Gastroenterol. 1994; 89: 1021-1026
        • Ong NT
        • Beasley SW
        Comparison of clinical methods for the assessment of continence after repair of high anorectal anomalies.
        Pediatr Surg Int. 1990; 5: 233-237
        • Cox DJ
        • Sutphen J
        • Borowitz S
        • et al.
        Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis.
        Ann Behav Med. 1998; 20: 70-76
        • Nolan T
        • Debelle G
        • Oberklaid F
        • et al.
        Randomised trial of laxatives in treatment of childhood encopresis.
        Lancet. 1991; 338: 523-527