The Role of Bowel Management in Children with Bladder and Bowel Dysfunction
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Purpose of Review
Bladder and bowel dysfunction is a common pediatric disorder that involves lower urinary tract symptoms (LUTS) as well as constipation and/or encopresis. Effective treatment of constipation in these patients leads to resolution or improvement of urinary symptoms in the majority of cases. Because many of these children initially present to the urologist with the primary complaint of LUTS, it is important for the consulting specialist to be well-versed on the topic of constipation. This review aims to provide an evidence-based guide on the evaluation and management of constipation in children.
Recent papers have improved our knowledge on the utilization of interventions such as antegrade continence enemas and sacral nerve stimulation for more recalcitrant cases of constipation. Although there have been limited advancements in the use of pharmacologic therapies for the treatment of constipation in children, it is hoped that newer therapeutic agents proven effective for adult constipation will gain pediatric use over time.
Present therapy for constipation in BBD is effective for the majority of patients. There is promise for further improvement in treatment options in the near future.
KeywordsConstipation BBD Lower urinary tract symptoms Dysfunctional elimination syndrome Children Treatment
Compliance with Ethical Standards
Conflict of Interest
Drs Bernal, Dole, and Thame have no financial relationships relevant to this article to report.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.McGrath KH, Caldwell PHY , Jones MP. The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting. J Paediatr Child Health 200844(1–2):19–27. https://doi.org/10.1111/j.1440-1754.2007.01207.x.
- 11.Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society. Neurourol Urodyn. 2016;35(4):471–81. https://doi.org/10.1002/nau.22751.CrossRefPubMedGoogle Scholar
- 20.•• Tabbers MM, Di Lorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258–74. https://doi.org/10.1097/MPG.0000000000000266. It provides consensus recommendations on the evaluation and treatment of childhood constipation from worldwide experts. CrossRefPubMedGoogle Scholar
- 23.Pensabene L, Buonomo C, Fishman L, Chitkara D, Nurko S. Lack of utility of abdominal x-rays in the evaluation of children with constipation: comparison of different scoring methods. J Pediatr Gastroenterol Nutr. 2010;51(2):155–9. https://doi.org/10.1097/MPG.0b013e3181cb4309.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Burgers RE, Mugie SM, Chase J, Cooper CS, von Gontard A, Rittig CS, et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2013;190(1):29–36. https://doi.org/10.1016/j.juro.2013.01.001.CrossRefPubMedGoogle Scholar
- 42.NASPGHAN. NASPGHAN position on Miralax use in children. 2015. https://cmcpediatrics.com/2015/01/naspghan-position-miralax-use-children/. Accessed 2 Dec 2017.
- 43.Zanetti G, Marchiori E, Gasparetto TD, Escuissato DL, Soares Souza A. Lipoid pneumonia in children following aspiration of mineral oil used in the treatment of constipation: high-resolution CT findings in 17 patients. Pediatr Radiol. 2007;37(11):1135–9. https://doi.org/10.1007/s00247-007-0603-1.CrossRefPubMedGoogle Scholar
- 48.Piessevaux H, Corazziari E, Rey E, Simren M, Wiechowska-Kozlowska A, Kerstens R, et al. A randomized, double-blind, placebo-controlled trial to evaluate the efficacy, safety, and tolerability of long-term treatment with prucalopride. Neurogastroenterol Motil. 2015;27(6):805–15. https://doi.org/10.1111/nmo.12553.CrossRefPubMedGoogle Scholar
- 49.•• IJN K, Di Lorenzo C, Saps M, Dinning PG, Yacob D, Levitt MA, et al. Childhood constipation: finally something is moving! Expert Rev Gastroenterol Hepatol. 2016;10(1):141–55. https://doi.org/10.1586/17474124.2016.1098533. This evidence-based review discusses the most recent developments in the evaluation and treatment of constipation in childhood. CrossRefGoogle Scholar
- 51.Wong BS, Camilleri M, McKinzie S, Burton D, Graffner H, Zinsmeister AR. Effects of A3309, an ileal bile acid transporter inhibitor, on colonic transit and symptoms in females with functional constipation. Am J Gastroenterol. 2011;106(12):2154–64. https://doi.org/10.1038/ajg.2011.285.CrossRefPubMedGoogle Scholar
- 54.• Arya S, Gupta N, Gupta R, Aggarwal A. Constipation and outcomes of cecostomy. Am J Ther. 2016;23(6):e1867–75. https://doi.org/10.1097/MJT.0000000000000417. Provides an up-to-date summary of 12 studies investigating the efficacy of ACE therapy, concluding that it is a promising option for patients with severe, refactory constipation and fecal incontinence. CrossRefPubMedGoogle Scholar
- 59.Rodriguez L, Nurko S, Flores A. Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility. Neurogastroenterol Motil. 2013;25(2):140–e81. https://doi.org/10.1111/nmo.12018.CrossRefPubMedGoogle Scholar
- 60.Dolejs SC, Smith JK, Sheplock J, Croffie JM, Rescorla FJ. Contemporary short- and long-term outcomes in patients with unremitting constipation and fecal incontinence treated with an antegrade continence enema. J Pediatr Surg. 2017;52(1):79–83. https://doi.org/10.1016/j.jpedsurg.2016.10.022.CrossRefPubMedGoogle Scholar
- 70.Keshtgar AS, Ward HC, Sanei A, Clayden GS. Botulinum toxin, a new treatment modality for chronic idiopathic constipation in children: long-term follow-up of a double-blind randomized trial. J Pediatr Surg. 2007;42(4):672–80. https://doi.org/10.1016/j.jpedsurg.2006.12.045.CrossRefPubMedGoogle Scholar
- 78.Janssen PTJ, Meyer YM, SMJ VK, Benninga MA, LPS S, Bouvy ND, et al. Long-term outcome of intractable constipation treated by sacral neuromodulation: a comparison between children and adults. Color Dis. 2017; https://doi.org/10.1111/codi.13837.
- 79.Van der Wilt AA, van Wunnik BPW, Sturkenboom R, Han-Geurts IJ, Melenhorst J, Benninga MA, et al. Sacral neuromodulation in children and adolescents with chronic constipation refractory to conservative treatment. Int J Color Dis. 2016;31(8):1459–66. https://doi.org/10.1007/s00384-016-2604-8.CrossRefGoogle Scholar
- 81.Veiga ML, Lordêlo P, Farias T, Barroso U. Evaluation of constipation after parasacral transcutaneous electrical nerve stimulation in children with lower urinary tract dysfunction—a pilot study. J Pediatr Urol. 2013;9(5):622–6. https://doi.org/10.1016/j.jpurol.2012.06.006.CrossRefPubMedGoogle Scholar
- 83.•• Sulkowski JP, Nacion KM, Deans KJ, Minneci PC, Levitt MA, Mousa HM, et al. Sacral nerve stimulation: a promising therapy for fecal and urinary incontinence and constipation in children. J Pediatr Surg. 2015;50(10):1644–7. https://doi.org/10.1016/j.jpedsurg.2015.03.043. This study demonstrates the success of sacral nerve stimulation (SNS) in the BBD population, specificall. While most studies aim to evaluate urinary and bowel outcomes separately, this group measured the efficacy of SSN for treatment of both systems. CrossRefPubMedGoogle Scholar
- 86.Lu PL, Koppen IJN, Orsagh-Yentis DK, Leonhart K, Ambeba EJ, Deans KJ, et al. Sacral nerve stimulation for constipation and fecal incontinence in children: long-term outcomes, patient benefit, and parent satisfaction. Neurogastroenterol Motil. 2017; https://doi.org/10.1111/nmo.13184.