Defecation In Children Research Articles

Functional constipation and posture in defecation

Background Functional constipation is often a consequence ofhabitual bowel elimination while sitting on common toilet seats.A considerable proportion of the population with n ormal bowelmovement frequency has difficulty emptying their bowels. Theprincipal cause of this problem may be the obstructive nature ofthe rectoanal angle and its relationship to the posture normallyused in defecation.Objective To assess the relationship between functional constipationwith the posture (sitting vs squatting) during defecationin children.Methods We conducted a cross-sectional study in November2010. Participants aged 12- 15 years were selected consecutivelyfrom a junior high school in Medan . Parents and children filledquestionnaires and were interviewed. Functional constipation wasassessed based on the Rome III criteria.Results Sixty-five students enrolled in the study. There was nostatistically significant diffe rences in subjects' characteristics.T here was a significant correlation between functional constipationwith posture during defecation in children (RR= 0.06, 95%CI0.02 to 0.25; P=0.0001). Functional constipation was more likelyoccured in children with sitting (12/20) th an squatting posture(4/45) during defecation.Conclusion We found th at posture in defecation is correlatedto functional con stipation in children.

An improved tool for household faeces management in rural Bangladeshi communities

To explore child defecation and faeces management practices in rural Bangladesh with the aim to redesign and pilot a tool to facilitate removal and disposal of faeces. We conducted six group discussions, six short interviews and three observations of practices and designed the new tool. We piloted the new tool and elicited feedback through two in-depth interviews and two observations. Until three years of age, a child commonly defecates in the courtyard and occasionally inside the house. A heavy digging hoe was commonly used to remove child faeces. Mothers preferred a redesigned 'mini-hoe' and found it easier to use for removal and disposal of liquid faeces. Promoting modified local tools may contribute to improving environmental sanitation and health.

Physiotherapy aids defecation in constipated children

Physiotherapy aids defecation in constipated children

Daily transabdominal electrical stimulation at home increased defecation in children with slow-transit constipation: a pilot study

Purpose Transcutaneous electrical stimulation (TES) (3 sessions/wk) over the abdomen stimulated bowel functions in a randomized controlled trial. This pilot study assessed whether daily TES at home with a safe, portable machine would be possible and more efficacious than trial results. Methods Eleven patients (6 male/5 female; mean age, 14 years; range, 12-18 years) with slow-transit constipation who relapsed or responded poorly in the trial were recruited (11 ± 5 months later). An EPM-IF-4160 (Fuji Dynamics, Hong Kong) portable machine (sine waveform, 4 kHz carrier frequency, 80-160 Hz beat frequency, intensity <33 mA) delivering interferential current (2 electrodes over epigastrium + 2 over kidneys) was applied 1 hour daily at home. Continence diaries were kept for 1 month before and 2 months during treatment. Results All children completed more than 1 month of treatment after baseline recording. Defecation increased in 9 of 11 children, and soiling decreased in 4 of 11 children. There was a significant increase in total episodes of defecation per week (mean ± SD, 2.5 ± 2.1 vs 6.7 ± 4.4; P = .008) and a nonsignificant decrease in soiling (3.8 ± 1.6 vs 1.1 ± 0.5 episodes/wk, P = .1). Daily stimulation does not affect abdominal pain. No adverse events occurred. Conclusions Daily TES at home is safe and significantly improved bowel function in children who did not respond to 3 times per week of TES. Home TES may be a novel treatment of intractable slow transit constipation, avoiding hospital visits.

24-Hour Rectal Manometry for Overactive Bladder

We describe prolonged rectal manometry used to characterize rectal motor activity patterns and possible rectum-bladder interaction during defecation and micturition in children with nonneuropathic overactive bladder. We evaluated 10 children with a mean +/- SD age of 9.7 +/- 1.3 years with overactive bladder who underwent urodynamics and 24-hour rectal manometric recording. All records were analyzed visually. Rectal contractions were defined as pressure runs exceeding 5 cm H(2)O and lasting longer than 5 seconds. Three rectal motility patterns were noted in all children, including 1) slow tonic pressure waves with a frequency of 3 to 12 per hour, b) rectal motor complexes with a frequency of 3 to 10 per minute and c) single contractions 10 to 30 seconds in duration. The median nocturnal duration of rectal motor complexes was longer than that during the day (16.3 minutes, range 10.8 to 18.8 vs 11.0, range 8.9 to 12.6, p <0.05). As a percent of time, median total contraction time was greater at night than during the day (51.9%, range 42.6% to 56.9% vs 30.6%, range 19.4% to 49.3%, p <0.05). Characteristic rectal activity was seen during defecation and voiding but no bladder-rectum interaction was detected. We identified 3 rectal motility patterns in all children with overactive bladder. Like the upper gastrointestinal tract, the rectum shows some periodic motor activity, which is more frequent at night. No association was observed between bladder and rectal activity during micturition and defecation.

Role of anorectal manometry in children with severe constipation

Constipation is one of the most frequent disorders of the digestive tract in children and it can be an important problem in paediatric and surgical practice. Most of the time, the cause is psychological or because of a slowing of colonic transit, but it can be a sign of organic gastrointestinal outlet obstruction. Some patients with chronic constipation are resistant to a medical approach and they present with a severe form of constipation that needs recurrent hospital admission. Anorectal manometry (ARM) is a noninvasive procedure and it helps to explain the mechanisms of defecation disorders. The aim of the present study was to evaluate the role of ARM in children with severe constipation. From October 2003 to October 2006, in the Paediatric Surgery Unit, 85 children - aged more than 1 year - with severe constipation were seen. The mean age was 5 years (range, 1-13). At presentation, every child had abdominal and rectal examination in order to identify abdominal distension or faecal masses. Bowel preparation with enemas was performed before ARM in patient with a rectal faecaloma. Myoelectric activity of the internal anal sphincter and resting anal tone was recorded; recto-anal inhibitory reflex (RAIR) was tested to exclude Hirschsprung's disease (HD). Anal tone was considered normal until 50 cm H(2)O. When the RAIR was absent, the patient underwent rectal suction biopsies (RSB) for histology and acetylcholinesterase histochemistry. In cases of normal or high anal tone with the RAIR present, the child had bowel cleaning, medical treatment, 2- and 6-month follow-up. Children with ineffective treatment at follow-up underwent RSB. In case of HD, a laparoscopic-assisted endorectal pull-through (ERPT) according to Georgeson's technique was performed. Seventy per cent of the patients had bowel preparation before ARM. In four patients the ARM was impossible to assess because of crying. In 28 patients, the anal tone result was higher than 50 cm H(2)O and local treatment with anaesthetic agents was used for 8 weeks. Seventeen patients underwent RSB: 11 patients with RAIR absent/unclear, 4 noncooperative children and 2 patients with ineffective medical treatment at follow-up. HD was diagnosed in 2 patients and laparoscopic-assisted ERPT was performed. The remaining patients had good results at 6-month follow-up. ARM is a noninvasive diagnostic tool to study the mechanism of defecation in children with constipation in order to prescribe the appropriate treatment. This procedure can be used in every child - aged more than 1 year - with severe constipation and assessment of the RAIR can select the cases for RSB.

Pelvic Floor Muscle Dysfunction

In Brief Pelvic floor muscle dysfunction is a problem that affects women of all ages. The disorder can present as chronic pelvic pain, dyspareunia, rectal pain, chronic constipation, lower back pain, and a wide array of other complaints. As a result of the various presenting symptoms, patients with pelvic floor muscle dysfunction are seen by a variety of health care workers, including obstetrician-gynecologists, urogynecologists, urologists, colorectal surgeons, orthopedic surgeons, physical therapists, chiropractors, pain management specialists, psychotherapists, and others. The purpose of this review is to discuss the etiology, symptomatology, associated conditions, diagnostic tools, and treatment options for this condition. The supportive function of the female pelvic floor is generally achieved by a combination of multiple components working together in a highly coordinated, specialized fashion. This intricate unit is made up of bones, ligaments, muscles, connective tissue, visceral organs, nerves, and vessels. These components are involved in a wide variety of functions that range from simple acts, such as sitting, standing, and walking to more complicated ones, such as child birth, micturition, and defecation. The dynamic capacity of the pelvic floor can be traumatized by a number of events and this can lead to pelvic floor dysfunction. It is important to review the anatomy and function of the pelvic floor, and recognize potential causes for damage and options for treatment when there is dysfunction. Pelvic floor muscle dysfunction is a condition that can exist on its own or in association with other conditions. It is frequently unrecognized because many health care providers are not specifically looking for it as a potential cause for patient complaints. Treatment usually involves a multidisciplinary approach.

Functional urinary and fecal incontinence in neurologically normal children: symptoms of one ‘functional elimination disorder’?

To clarify the relationship between disordered defecation and non-neuropathic bladder-sphincter dysfunction (NNBSD) by comparing the prevalence of symptoms of disordered defecation in children with NNBSD before and after treatment for urinary incontinence (UI), and assessing the effect of such symptoms on the cure rate for UI. In the European Bladder Dysfunction Study, a prospective multicentre study comparing treatment plans for children with NNBSD, 202 children completed questionnaires on voiding and on defecation, at entry and after treatment for UI. Four symptoms of disordered defecation were evaluated; low defecation frequency, painful defecation, fecal soiling, and encopresis. At entry, 17 of the 179 children with complete data sets had low defecation frequency and/or painful defecation (9%), classified as functional constipation (FC). Of the 179 children, 57 had either isolated fecal soiling or soiling with encopresis (32%), classified as functional fecal incontinence (FFI). After treatment for UI, FFI decreased to 38/179 (21%) (statistically significant, P = 0.035); for FC there were too few children for analysis. After treatment for UI, 19 of the 179 children (11%) reported de novo FFI. Symptoms of disordered defecation did not influence the cure rate of treatment for UI. FFI improved significantly after treatment for UI only, but not in relation to the outcome of such treatment. FFI did not influence the cure rate for UI. There was little to support a causal relation between disordered defecation and NNBDS ('functional elimination syndrome').

Prevalence and intensity of infections of Ascaris lumbricoides and Trichuris trichiura and associated socio-demographic variables in four rural Honduran communities.

Between January and March 1998, a cross-sectional survey was carried out in four rural communities in Honduras, Central America. We examined the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infections among 240 fecal specimens, and the association between selected socio-demographic variables and infection for 62 households. The overall prevalence of A. lumbricoides and T. trichiura was 45% (95% CI 39.0-51.9) and 38% (95% CI 31.8-44.4) respectively. The most intense infections for Ascaris and Trichuris were found in children aged 2-12 years old. By univariate analysis variables associated with infections of A. lumbricoides were: number of children 2-5 years old (p=0.001), level of formal education of respondents (p=0.01), reported site of defecation of children in households (p=0.02), households with children who had a recent history of diarrhea (p=0.002), and the location of households (p=0.03). Variables associated with both A. lumbricoides and T. trichiura infection included: number of children 6-14 years old (p=0.01, p=0.04, respectively), ownership of a latrine (p=0.04, p=0.03, respectively) and coinfection with either helminth (p=0.001, p=0.001, respectively). By multivariate analysis the number of children 2-5 years living in the household, (p=0.01, odds ratio (OR)=22.2), children with a recent history of diarrhea (p=0.0, OR=39.8), and infection of household members with T. trichiura (p=0.02, OR=16.0) were associated with A. lumbricoides infection. The number of children 6-14 years old in the household was associated with both A. lumbricoides and T. trichiura infection (p=0.04, p=0.01, OR=19.2, OR=5.2, respectively).

Intolerance of cowʼs milk and chronic constipation in children

Background: Chronic diarrhea is the most common gastrointestinal symptom of intolerance of cow's milk among children. On the basis of a prior open study, we hypothesized that intolerance of cow's milk can also cause severe perianal lesions with pain on defecation and consequent constipation in young children. Methods: We performed a double-blind, crossover study comparing cow's milk with soy milk in 65 children (age range, 11 to 72 months) with chronic constipation (defined as having one bowel movement every 3 to 15 days). All had been referred to a pediatric gastroenterology clinic and had previously been treated with laxatives without success; 49 had anal fissures and perianal erythoma or edema. After 15 days of observation, the patients received cow's milk or soy milk for 2 weeks. After a one week washout period, the feedings were reversed. A response was defined as eight or more bowel movements during a treatment period. Results: Forty-four of the 65 children (68 percent) had a response while receiving soy milk. Anal fissures and pain with defecation resolved. None of the children who received cow's milk had a response. In all 44 children with a response, the response was confirmed with a double blind challenge with cow's milk. Children with a response had a higher frequency of coexistent rhinitis, dermatitis, or bronchospasm than those with no response (11 of 44 children vs. 1 of 21, P = 0.05); they were also more likely to have anal fissures and erythema or edema at base line (40 of 44 vs. 9 of 21, P < 0.001), evidence of inflammation of the rectal mucosa on biopsy (26 of 44 vs. 5 of 21, P = 0.008), and signs of hypersensitivity, such as specific IgE antibodies to cow's-milk antigens (31 of 44 vs. 4 of 21, p < 0.001). Conclusions: In young children, chronic constipation can be a manifestation of intolerance of cow's milk.

Feces, flies, and fetor: findings from a Peruvian shantytown.

Sanitary disposal of feces is vital to combat childhood diarrhea, and its promotion is key to improving health in developing countries. Knowledge of prevailing feces disposal practices is a prerequisite to formulation of effective intervention strategies. Two studies were conducted in a shantytown area of Lima, Peru. First, information was gathered through in-depth interviews with mothers and structured observations (4 hours) of young children and their caretakers. Data on beliefs and practices related to feces disposal behaviors were obtained. Excreta were deposited by animals or humans in or near the house in 82% of households observed. Beliefs about feces depended on their source and were reflected in how likely the feces were to be cleared. While 22% of children aged > or = 18 months were observed to use a potty for defecation, 48% defecated on the ground where the stools often remained. Although almost all children were cleaned after defecation, 30% retained some fecal matter on their body or clothes. Handwashing after the child's defecation was extremely rare for both children (5%) and caretakers (20%). The hygienic disposal of feces poses problems in this type of community. Nevertheless existing practices were found that show promise for promotion on a wider scale, including greater use of potties.

Management of childhood constipation

From the child's perspective chronic constipation and soiling can be a source of constant physical and mental anguish. Whether the onset relates to battles over potty training or painful defaecation as a result of acute constipation, the child attempts to avoid the difficulty by withholding defaecation. 1 Partin JC Hamill SK Fischel JE Partin JS Painful defecation and fecal soiling in children. Pediatrics. 1992; 89: 1007-1009 PubMed Google Scholar Initially this action results in infrequent passage of larger, harder, and even more painful stools. Subsequently when the rectum is adequately distended and the anorectal physiology sufficiently disturbed, normal defaecation may be suspended to be replaced by soiling. This loss of continence is likely to be treated with dismay and anger by an uncomprehending family. Biofeedback training in treatment of childhood constipation: a randomised controlled studyAdditional biofeedback training compared to conventional therapy did not result in higher success rates in chronically constipated children. Furthermore, achievement of normal defaecation dynamics was not associated with success: abnormal defaecation dynamics seem not to play a crucial role in the pathogenesis of childhood constipation. Intensive conventional laxative treatment should remain the first choice in chronically constipated children. Full-Text PDF

An Overview of the Effects of Dietary Fiber on Gastrointestinal Transit

This article is a review of the effects that ingested dietary fiber has on gastrointestinal transit time. The various phases of gastrointestinal motility are considered, and the effect of fiber on these various components is explored. Fiber affects each phase of gastrointestinal motility differently; however, the most dramatic effect on decreased transit time and frequency of bowel movements result from the variations it causes in colonic transit time. The mechanisms of defecation in children and the ways in which fiber affects the frequency of bowel movements are emphasized. All types of fiber do not affect gastrointestinal transit in a similar manner, and different preparations of the same fiber either may delay or may increase the time of intestinal transit. In general, fiber is found to increase the frequency of bowel movements and may prove to be of considerable benefit in treating constipation, a common childhood disorder.

Child defecation behaviour, stool disposal practices, and childhood diarrhoea in Burkina Faso: results from a case-control study.

To investigate the association between where young children defecate, where stools are disposed of, and the presence of human stools on the ground in the compound and the rate of hospital admission with diarrhoea. This was a case-control study with two control groups. The study took place in Bobo-Dioulasso, the second city of Burkina Faso in West Africa. Three groups of children aged 36 months and under, and living in Bobo-Dioulasso were studied. Cases were 757 children admitted to hospital with symptoms of diarrhoea or dysentery. The first control group comprised 757 neighbourhood control children approximately matched on age and date of recruitment, and the second, 631 children admitted to the same hospital without symptoms of diarrhoea or dysentery. There was no evidence of any association between where the child was reported to defecate and hospital admission with diarrhoea or dysentery (odds ratio = 1.10; 95% confidence interval (CI) 0.78, 1.57, cases v neighbourhood controls; odds ratio = 0.84; 95% CI 0.60, 1.18, cases v hospital controls). There was evidence of an association between where the mother reported disposing of the child's stools and hospital admission with diarrhoea or dysentery (odds ratio = 1.50; 95% CI 1.09, 2.06, cases v neighbourhood controls; odds ratio = 1.31; 95% CI 0.96, 1.79, cases v hospital controls). Human stools were more frequently observed in the yards of cases than controls (odds ratio = 1.38; 95% CI 0.98, 1.95, cases compared with neighbourhood controls; odds ratio = 1.33; 95% CI 0.96, 1.84, cases compared with hospital controls). The findings suggest that it is not where the child defecates that matters but how the mother then deals with the child's stools.

Defecation in normal infants and children: Clinical assessment of anal continence

Defecation in normal infants and children: Clinical assessment of anal continence

Infrequent defecation in children

Infrequent defecation in children

Infrequent Defecation in Children

To the Editor.— I am writing in reference to the question concerning infrequent defecation or Hirschsprung's disease and the reply to it by Dr Kirschner in the Jan 23/30, 1987, issue of JAMA . 1 There are several points stated, implied, or omitted that should upset any physician caring for children. In the first place, two stools per week in a baby who is primarily breast-fed is, of itself, no cause for alarm. As there is little waste in breast milk, many children will go longer than a week between bowel movements; in this case, the supplemental bottle may be modifying the pattern. The main point of concern would be the foul odor of these soft stools (the green color may arise from iron in the formula). Good growth argues against a malabsorption problem, but nevertheless cystic fibrosis should be of at least equal concern to Hirschsprung's disease. Furthermore, the results

Disorders of defecation in children

In a series of 123 children with disorders of defecation, constipation was the main problem in 89 and fecal incontinence in 34. All but three of the latter also had constipation. The principal physical findings were abdominal protuberance with palpable stool in the bowel and the presence of a fecal mass in the rectal ampulla. Laboratory and radiologic findings were nonspecific except in two of the three patients found to have congenital megacolon (Hirschsprung's disease). Rectal suction biopsy, performed in 69 patients, was diagnostic in all three with Hirschsprung's disease. Anorectal manometry, done in 11 patients, was of limited value. In general, treatment consists of patience and understanding on the part of physician and family, a regimen of orally administered (noncathartic) laxatives with dose gradually reduced over weeks to months, frequent telephone communication between physician and parents, and occasional office visits. Patients with nonretentive fecal incontinence require an intensive psychologic approach. A patient, empathetic, and available physician is one of the most important ingredients in the treatment regimen.

Diagnosis and Treatment of Disorders of Defecation in Children

Diagnosis and Treatment of Disorders of Defecation in Children