Abstract
Functional non-retentive fecal incontinence (FNRFI) is a common problem in pediatric age. FNRFI is defined as unintended loss of stool in a 4-year-old or older child after organic causes have been excluded. FNRFI tends to affects up to 3% of children older than 4 years, with males being affected more frequently than females. Clinically, children affected by FNRFI have normal intestinal movements and stool consistency. Literature data show that children with fecal incontinence have increased levels of separation anxiety, specific phobias, general anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder. In terms of possible relationship between incontinence and sleep, disorders of sleep organization have been observed in the pathogenesis of enuresis so generating the hypothesis that the orexinergic system may have a crucial role not only for the sleep organization per se but also for the sphincterial control in general. This study aimed to focus on specific neurophysiological aspects to investigate on the possible relationship between sleep organizational abnormalities and FNRFI. Specifically, we aimed to measure orexin serum levels in children with FNRFI and assess their polysomnographic sleep macrostructure patterns. Two study groups were considered: FNFRI (n = 45) and typically developed (TD) (n = 45) group. In both groups, sleep patterns and respiratory events were assessed by polysomnographic recordings (PSG) during a period of two nights at least, and plasma levels of Orexin-A were measured in each participant. The findings of this initial investigation seem to support a major role of Orexin-A in sleep organization alterations in children with FNFRI. Also, our data suggest that sleep habits evaluation should be considered as screening and complementary tool for the diagnosis of fecal incontinence in children.
Highlights
Functional non-retentive fecal incontinence (FNRFI) is a relatively common problem in pediatric age [1]
Our findings show that FNRFI children have a relevant reduction in sleep stages representation, mainly resumed in the lack of adequate sleep duration and reducing noteworthy sleep efficiency
Children with FNRFI have been described as having more symptoms of anxiety/depression, family environment with less expressiveness and poor organization, greater attention difficulties, more social problems, more destructive behaviors and school-based school performance [30]
Summary
Functional non-retentive fecal incontinence (FNRFI) is a relatively common problem in pediatric age [1]. FNRFI is associated with high levels of distress for both children and parents and with emotional disorders in about 30–50% of affected children [2]. IV criteria [3] fecal incontinence is defined as unintended loss of solid or liquid stool occurring in inappropriate places in a 4-year-old or older child after organic causes have been ruled out. Epidemiological data are still contrasting and the estimated prevalence depending on the definition used, FNRFI tends to affects up to 3% of children older than 4 years [4,5]. Males seem to be affected more frequently than females and daytime FNRFI is more frequent than nocturnal FNRFI, which is most often due to organic causes [6]
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