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ABSTRACT: PURPOSE: To investigate two different diagnostic tests to assess the rectal filling state. MATERIAL AND METHODS: Rectal filling state was assessed by transabdominal ultrasound (US) or by digital rectal examination (RE), by two independent investigators, in children with urological problems, prior to a scheduled diagnostic or surgical urological procedure. A dilated rectum filled with stool or large amounts of (usually) hard stool were both considered as a rectal fecal mass. All investigations were performed under general anesthesia. The kappa test was used to evaluate agreement between US and RE. RESULTS: A total of 84 children (54 boys) with a median (p25-p75) age of 9.0 years (6.4- 11) were eligible candidates. A rectal mass was found upon US and RE,in 32% and 41% of all children, respectively, with agreement between the two tests in 82.5%. Cohen's kappa showed good agreement of 0.62 (95% CI 0.45-0.79) between US and RE. The median (interquartile) diameter of the rectum was 3.3 cm (2.8-3.9) in children with a full rectum and respectively, 2.5 cm (1.8-2.8) and 2.0 cm (1.5-2.2) in patients with a half-filled and empty rectum. CONCLUSION: Transabdominal ultrasound is a non-invasive and reliable alternative to assess the rectal filling state and might replace digital RE in the work-up of children with constipation.
The Journal of urology 03/2013; · 4.02 Impact Factor
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ABSTRACT: OBJECTIVE: To assess the current treatment of functional nonretentive fecal incontinence, which consists of education, toilet training, and positive motivation. STUDY DESIGN: Patients, age 6 years and older, referred for fecal incontinence (FI) and diagnosed with functional nonretentive fecal incontinence were eligible candidates. Seventy-one children (76% boys, median age 9.3 years) were randomized to receive conventional therapy (control group) or conventional therapy in addition to daily enemas during 2 weeks. Treatment success was defined as <2 episodes of FI/month without use of enemas. RESULTS: At intake, the median FI frequency was 6.1 per week, whereas the median defecation frequency was 7.0 per week. At the end of the treatment period, the median number of FI episodes was significantly decreased in both groups: from 7.0 (IQR 4.0-11.5) to 1.0 (IQR 0.5-2.0) in the intervention group and from 6.0 (IQR 4.0-10) to 2.0 (IQR 0.5-3.5) in the control group. No statistical difference was found between the groups at the end of the treatment period (P = .08) nor during additional follow-up (average success rate 17% for both groups, P = .99). CONCLUSION: Temporarily application of additional rectal enemas did not significantly improve treatment success compared with conventional therapy alone.
The Journal of pediatrics 11/2012; · 4.02 Impact Factor
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ABSTRACT: To evaluate the prevalence of pediatric functional defecation disorders (FDD) using the Rome III criteria and to compare these data with those obtained using Rome II criteria.
A chart review was performed in patients referred to a tertiary outpatient clinic with symptoms of constipation and/or fecal incontinence. All patients received a standardized bowel questionnaire and physical examination, including rectal examination. The prevalence of pediatric FDD according to both Rome criteria sets was assessed.
Patients with FDD (n = 336; 61% boys, mean age 6.3 ± 3.5 SD) were studied: 39% had a defecation frequency ≤2/wk, 75% had fecal incontinence, 75% displayed retentive posturing, 60% had pain during defecation, 49% passed large diameter stools, and 49% had a palpable rectal fecal mass. According to the Rome III criteria, 87% had functional constipation (FC) compared with only 34% fulfilling criteria for either FC or functional fecal retention based on the Rome II definitions (P < .001). Of the patients with a rectal fecal mass, 95% would also have been correctly identified as having FC without a rectal examination. Twenty-nine patients (11%) fulfilled the criteria for functional nonretentive fecal incontinence according to both the Rome II and Rome III criteria.
The pediatric Rome III criteria for FC are less restrictive than the Rome II criteria. The Rome III criteria are an important step forward in the definition and recognition of FDD in children.
The Journal of pediatrics 05/2012; 161(4):615-620.e1. · 4.02 Impact Factor
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ABSTRACT: To investigate and compare the approach to childhood constipation by primary care physicians (PCP) in three Western countries to give insight into adherence to current guidelines and in actual care.
Prospective study utilizing a two-page survey regarding the approach to children suspected to have functional constipation (FC). A total of 413 of 1016 (41%) distributed surveys were returned out of which 383 were suitable for analysis. Surveys were answered anonymously. Survey responses were analysed and are reported in a descriptive way.
In Italy, the Netherlands, and the USA, respectively, 75, 187 and 121 surveys were returned by PCP. The majority of PCP (62%) considered stool withholding as a result of painful defecation to be the most common cause of childhood constipation. Rectal examination was used as a standard diagnostic tool for the evaluation of FC by only 31% of PCP with significant differences among the countries (p < 0.05) and a minimum in the Netherlands (11%). Abdominal X-ray is used by 49% to diagnose FC. 63% of PCP were convinced that hard stool can be softened by drinking more water. Polyethylene glycol was the most common prescribed drug (85%). Significant differences were found among countries in the use of senna and bisacodyl suppositories (p < 0.05).
Significant differences in practice exist among PCP from different countries regarding the performance of a digital rectal examination, need for additional diagnostic tests and use of laxatives in childhood constipation.
Acta Paediatrica 02/2012; 101(6):677-80. · 2.07 Impact Factor
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ABSTRACT: We investigated the effect of rectal distention on lower urinary tract function.
Children were assigned to a constipation and lower urinary tract symptoms group or to a lower urinary tract symptoms only group. The definition of constipation was based on pediatric Rome III criteria. Standard urodynamics were done initially and repeated during simultaneous barostat pressure controlled rectal balloon distention and after balloon deflation. We evaluated the effects of rectal balloon inflation and deflation on urodynamic parameters. Colonic transit time measurement, anorectal manometry and the Parenting Rating Scale of child behavior were also used.
We studied 7 boys and 13 girls with a median age of 7.5 years who had constipation and lower urinary tract symptoms, and 3 boys and 3 girls with a median age of 7.5 years who had lower urinary tract symptoms only. Urodynamic patterns of response to rectal distention were inhibitory in 6 children and stimulatory in 12, and did not change in 8. In 54% of the cases balloon deflation reversed balloon inflation changes while in 46% balloon inflation changes persisted or progressed. No significant differences were noted in children with vs without constipation and no clinical symptom or diagnostic study predicted the occurrence, direction or degree of bladder responses.
In almost 70% of children with lower urinary tract symptoms rectal distention significantly but unpredictably affected bladder capacity, sensation and overactivity regardless of whether the children had constipation, and independent of clinical features and baseline urodynamic findings. Urodynamics and management protocols for lower urinary tract symptoms that fail to recognize the effects of rectal distention may lead to unpredictable outcomes.
The Journal of urology 10/2010; 184(4 Suppl):1680-5. · 4.02 Impact Factor
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ABSTRACT: Fecal incontinence is defined as the passage of stools in an inappropriate place at least once per month, for a minimum period of 2 months. This frustrating symptom is a source of considerable distress and embarrassment for the child and the family. According to the Rome III criteria fecal incontinence can be subdivided into constipation-associated fecal incontinence and functional nonretentive fecal incontinence. This short review mainly addresses functional nonretentive fecal incontinence in children. Definition, prevalence, pathophysiology, and recent updates on treatment and long-term follow-up of fecal incontinence are discussed.
Journal of pediatric gastroenterology and nutrition 05/2009; 48 Suppl 2:S98-S100. · 2.18 Impact Factor
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ABSTRACT: To gather data concerning bowel habits and toilet training of developmentally normal children ages 5 to 8 years.
A questionnaire containing information on age, race, and sex was completed anonymously by a parent in 9 pediatric practices. Recall information was elicited about onset and completion of toilet training, frequency and quality of stooling, size of bowel movements, and behavioral components of defecation.
Questionnaires were completed for 1142 children. When all of the children were considered together, toilet training started at a mean of 27.2 months and was completed at a mean of 32.5 months. It began and was completed nearly 3 months earlier for girls than for boys (P<0.001). African American children started and completed toilet training at least 6 months earlier than white children (P<0.001). Of the children, 95% defecated either daily or every other day. Straining at defecation and infrequent stooling were reported significantly more often for girls, whereas staining of underclothes and passage of large bowel movements were reported more often in boys. Approximately 10% of children fulfilled criteria for functional constipation.
Most of the children between 5 and 8 years of age have a medium-size bowel movement daily or every other day without straining or withholding. Although African American children toilet train at an earlier age than do white children, bowel habits appear to be similar. A sizeable subgroup of children presenting to primary care providers have a history that is consistent with constipation.
Journal of pediatric gastroenterology and nutrition 03/2009; 48(3):294-8. · 2.18 Impact Factor
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ABSTRACT: Objectives: To gather data concerning bowel habits and toilet training of developmentally normal children ages 5 to 8 years.
Methods: A questionnaire containing information on age, race, and sex was completed anonymously by a parent in 9 pediatric practices. Recall information was elicited about onset and completion of toilet training, frequency and quality of stooling, size of bowel movements, and behavioral components of defecation.
Results: Questionnaires were completed for 1142 children. When all of the children were considered together, toilet training started at a mean of 27.2 months and was completed at a mean of 32.5 months. It began and was completed nearly 3 months earlier for girls than for boys (P < 0.001). African American children started and completed toilet training at least 6 months earlier than white children (P < 0.001). Of the children, 95% defecated either daily or every other day. Straining at defecation and infrequent stooling were reported significantly more often for girls, whereas staining of underclothes and passage of large bowel movements were reported more often in boys. Approximately 10% of children fulfilled criteria for functional constipation.
Conclusions: Most of the children between 5 and 8 years of age have a medium-size bowel movement daily or every other day without straining or withholding. Although African American children toilet train at an earlier age than do white children, bowel habits appear to be similar. A sizeable subgroup of children presenting to primary care providers have a history that is consistent with constipation.
Journal of Pediatric Gastroenterology and Nutrition 02/2009; 48(3):294-298. · 2.30 Impact Factor
