Faecal incontinence in childhood : a multidisciplinary approach including biofeedback

Shepherd, K., Hickstein, R., Rose, V., Nasser, C., Cleghorn, Geoffrey J., & Shepherd, R. W. (1989) Faecal incontinence in childhood : a multidisciplinary approach including biofeedback. Australian Paediatric Journal, 25(6), pp. 351-355.

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One hundred and seven children with faecal incontinence were evaluated and managed over a 3 year period by a multidisciplinary team. After initial clinical assessment, evaluation of defaecatory mechanisms (using a balloon model) and assessment of personal-social development and self-concept were undertaken. Management was based on initial bowel evacuation, short-term laxatives, and habit training involving systematic use of positive reinforcement; 69 children received biofeedback conditioning. Idiopathic megacolon with constipation and soiling was the most common finding (98 cases). Other diagnoses included previously undiagnosed neurogenic bowel (three cases), post-surgical anal anomalies (four cases), and psychogenic encopresis (two cases). Idiopathic megacolon was characterized by decreased rectal sensation, increased threshold for external sphincter relaxation and an inability to evacuate. Faecal incontinence was associated with an undesirably low social self-concept (70% of the 40 evaluated), but was not related to a delay in development (mean general developmental quotient = 105 ± 8, for the 35 tested). Family psychopathology warranting referral for family therapy was found in 14 children (13%). The management programme yielded a short-term (3 months) cure rate of 68% and a long-term (12 months) cure rate of 90%, with 10% having continued soiling which varied from occasional to several incidents/week. No significant improvement in self-concept was observed overall, although marked improvements were observed in some children. We conclude that disordered defaecatory dynamics are a major determinant of faecal incontinence in children. Undesirably low social self-concepts but normal developmental ability accompany this condition. Management is facilitated by a multidisciplinary approach, acknowledging the role of both behavioural and physiological components of the problem. This approach is effective in eradicating soiling in the majority of cases, comparing favourably with other published data.

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ID Code: 90743
Item Type: Journal Article
Refereed: No
Additional Information: Cited By :7
Export Date: 1 September 2015
Correspondence Address: Shepherd, K.; Child Health Specialist Cent., Royal Children's Hospital, Brisbane, Queensland 4029, Australia
Additional URLs:
Keywords: biofeedback, chronic constipation, encopresis, faecal incontinence, article, child, constipation, family study, feces incontinence, feedback system, female, human, major clinical study, male, mental disease, priority journal, psychological aspect, Adolescent, Biofeedback (Psychology), Child, Preschool, Family Therapy, Fecal Incontinence, Follow-Up Studies, Rectum, Self Concept, Sensation
DOI: 10.1111/j.1440-1754.1989.tb02355.x
ISSN: 0004-993X
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Exercise & Nutrition Sciences
Deposited On: 25 Nov 2015 01:31
Last Modified: 25 Nov 2015 01:33

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