Abstract
Background
Fecal incontinence and constipation are major problems after correction of anorectal malformation (ARM), caused not only by the somatic defects but also by a psychosomatic dysfunction of defecation. To better release patients from this dysfunction we offered a multidisciplinary, psycho-and physiotherapeutic therapy according to an approach developed in Nijmegen (Netherlands). We herein summarize the preliminary results to evaluate whether the approach can be adopted with similar success.
Methods
Since January 2002 multidisciplinary behavioural treatment (MBT) has been offered to children above 3 years of age and suffering from fecal incontinence and constipation after surgical correction of ARM in our department or elsewhere. Prerequisites included no anal stenosis, regulation of stool consistency, and a suitable defecation diary over 2 weeks. MBT contained regular consultations by a pediatric psychologist and a physiotherapist, teaching the child to establish a regular defecation pattern and how to push while relaxing the pelvic floor. The entry-and post-treatment situation was prospectively monitored by means of defecation and constipation scoring systems.
Results
Complete data were available in 10 patients (9 males, 1 female) with high (8 patients) and low (2) forms of anal atresia initially, who finished MBT 2–36 months ago (mean: 13 months). The average amount of stool reaching the toilet was 27% before and 90% after therapy. Clean days were absent before, reaching 3.7 days on average after therapy. Constipation was present in 6 patients before (3 of them on enemas) and in 2 after therapy (no enemas needed). The duration of MBT was 7 months on average, range 3–23 months, with 8–9 sessions per patient, each lasting 60–90 minutes. An observation period of 7 months after treatment confirmed stable results. MBT turned out to improve body-consciousness and self-confidence.
Conclusions
MBT is effective in reducing incontinence and constipation in patients after ARM. It helps the children and their families to relieve psychosocial stress. The approach can be successfully adopted, if a team of committed specialists is available and sufficient compliance of patients and families is given. compliance of patients and families is given.
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References
Hassink EA, Rieu PN, Severijnen RS, Brugman-Boezeman AT, Festen C. Adults born with high anorectal atresia-how do they manage? Dis Colon Rectum 1996;39:695–699.
Pena A. Anorectal malformations. Semin Pediatr Surg 1995;4:35–47.
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.
van Kuyk EM, Brugman-Boezeman AT, Wissink-Essink M, Severijnen RS, Festen C, Bleijenberg G. Biopsychosocial treatment of defecation problems in children with anal atresia: a retrospective study. Pediatr Surg Int 2000;16:317–321.
van Kuyk EM, Wissink-Essink M, Brugman-Boezeman AT, Oerlemans HM, Nijhuis-van der Sanden MW, Severijnen RS, et al. Multidisciplinary behavioral treatment of defecation problems: a controlled study in children with anorectal malformations. J Pediatr Surg 2001;36:1350–1356.
Levitt MA, Pena A. Treatment of fecal incontinence. In: Holschneider AM, Hutson JM, eds. Anorectal malformations in children. Berlin: Springer, 2006:377–383.
Templeton JM Jr, Ditesheim JA. High imperforate anus—quantitative results of long-term fecal continence. J Pediatr Surg 1985;20:645–652.
Olness K, McParland FA, Piper J. Biofeedback: a new modality in the management of children with fecal soiling. J Pediatr 1980;96:505–509.
Konsten J, Baeten CG, Spaans F, Havenith MG, Soeters PB. Follow-up of anal dynamic graciloplasty for faecal continence. World J Surg 1993;17:404–409.
Lehur PA, Zerbib F, Neunlist M, Glemain P, Bruley SDV. Comparison of quality of life and anorectal function after artificial sphincter implantation. Dis Colon Rectum 2002;45:508–513.
Riedel JG, Festge OA. A new treatment method in severe fecal incontinence in children. Chirurg 1999;70:935–938.
Pena A, Guardino K, Tovilla JM, Levitt MA, Rodriguez G, Torres R. Bowel management for faecal incontinence in patients with anorectal malformations. J Pediatr Surg 1998;33:133–137.
Ludman L, Spitz L. Psychosocial adjustment of children treated for anorectal anomalies. J Pediatr Surg 1995;30:495–499.
Ginn-Pease ME, King DR, Tarnowski KJ, Green L, Young G, Linscheid TR. Psychosocial adjustment and physical growth in children with imperforate anus or abdominal wall defects. J Pediatr Surg 1991;26:1129–1135.
Diseth TH, Egeland T, Emblem R. Effects of anal invasive treatment and incontinence on mental health and psychosocial functioning of adolescents with Hirschsprung’s disease and low anorectal anomalies. J Pediatr Surg 1998;33:468–475.
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Schmiedeke, E., Busch, M., Stamatopoulos, E. et al. Multidisciplinary behavioural treatment of fecal incontinence and constipation after correction of anorectal malformation. World J Pediatr 4, 206–210 (2008). https://doi.org/10.1007/s12519-008-0038-2
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DOI: https://doi.org/10.1007/s12519-008-0038-2