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Background: Elimination disorder occurs in children over the age of normal toileting who continue to have an inability to control urination or feces, either during the day, at night, or both. Paediatric elimination disorders are not well understood by parents, teachers, medical professionals, mental health practitioners, and researchers. Hence, this study aimed to assess the magnitude of elimination disorder and associated factors among children and Adolescents aged 5–14 years old at Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, in 2022. Method: A hospital-based cross-sectional study was conducted from September 22 to November 22, 2022, at Wolaita Sodo University Comprehensive Specialized Hospital. A systematic random sampling technique was employed to select 423 study subjects. The data were gathered using a structured, face-to-face interviewer-administered questionnaire. The development of the symptom score for dysfunctional elimination syndrome of Vancouver questionnaires was used to screen for elimination disorders. Logistic regression model was used to determine the association between the outcome and independent variables. A 95% CI and Odds ratio with corresponding p-value < 0.05 were used to determine the predictors of the outcome variable. Result: The overall magnitude of elimination disorder among children and Adolescents age 5–14 in this study was (n 70, 16.8%); in boys (n 47, 17.3%) and girls (n 23, 15.75%). The prevalence of enuresis was (n 64, 15.3%), encopresis (n 15, 3.6%), both enuresis and encopresis, or combined elimination disorder (n 9, 2.2%). Age 9–11 years (AOR = 3.2, 95%CI:1.09, 9.43), family size four and above (AOR = 3.4, 95%CI:1.78, 6.56), family history of elimination disorder (AOR = 3.9, 95%CI:2.12, 7.45), emotional problem (AOR = 2.2, 95%CI:1.18, 4.05), hyperactive problem (AOR = 3.8, 95%CI:1.83, 7.83), low toilet training skills (AOR = 5.9, 95%CI:2.61, 13.33), bad parenting practices, were poor supervision (AOR = 4.4, 95%CI 1.29, 14.69) were significantly associated with elimination disorder. Conclusion and recommendation: In this study, approximately one in five children and adolescents had an elimination disorder. Younger age, family size four and above, positive family history of elimination disorder, presence of emotional and hyperactive problems, bad parenting practices, and low toilet training skills were factors associated with elimination disorders. Therefore, preventative, etiological, and therapeutic measure, early toilet training, supportive parenting practices, screening for children's and adolescents' behavioral problems, and elimination disorders need attention to reduce the effect of the problem. [ABSTRACT FROM AUTHOR]

The international literature has long established the importance of health issues presented by children entrusted to Child Protection and Welfare Service (Aide Sociale à l'Enfance –ASE, in France). This study examined the health of children entrusted to the ASE in Vendée (a French administrative region) in order to better understand and address their health needs. A retrospective study of all children (623 out of 920) aged 0–18 years placed in foster care or an institution during 2019 was carried out. The data collection was based on the information in the medical form completed by the doctor during the annual health check. More than one quarter of the children had a written or spoken language disorder, 32% of children did not have a normal body mass index for their age, 10% of children suffered from enuresis, 4% from encopresis, and sleep disorders were observed in 29% of the study population. Furthermore, 51% of the children expressed psychological distress by internalizing or externalizing it, and 6% of children over 6 years of age had already run away or put themselves in danger. The results of our study are congruent with the international literature and confirm that children and adolescents in out-of-home care (foster care, residential care) have significantly higher healthcare needs than their peers. The findings also suggest several areas for improving the healthcare of children and adolescents entrusted to the care of the child protection and welfare services. [ABSTRACT FROM AUTHOR]

Background: Children with constipation and encopresis are often treated with medication and behavioral approaches. When constipation persists, surgical interventions such as antegrade continence enema (ACE) procedures are considered. Many children benefit from these procedures; however, some children continue to have incontinence, experience complications, or discontinue the use of the ACE stoma. There is some evidence in the literature to indicate that psychosocial factors can have an impact on ACE outcomes; however, standardized biopsychosocial guidelines related to ACE candidacy and surgery do not currently exist. Purpose: The purpose of this review is to summarize the research to date on psychosocial factors related to ACE treatment outcomes and complications. Identifying what is known and what limitations remain can support future research to inform development of guidelines for pre‐procedure evaluations. Psychosocial pre‐procedure evaluations could help to inform eligibility for the procedure as well as interventions to enhance outcomes for children at increased risk for poor outcomes or complications from ACE. Age, psychiatric symptoms, and adherence to the ACE flush regimen were some of the factors identified in the literature as impacting ACE outcomes; however, there is limited research in this area. [ABSTRACT FROM AUTHOR]

Background: Elimination disorders are highly prevalent in childhood and often associated with clinically relevant comorbid psychological disorders. The aim of this study is to determine if, and to what extent, children with elimination disorders show higher internalizing and externalizing problems than their healthy peers. Methods: A multistep literature search was performed from database inception until May 1st, 2022. PRISMA/MOOSE‐compliant systematic review (PROSPERO: CRD42022303555) were used to identify studies reporting on internalizing and/or externalizing symptoms in children with an elimination disorder and a healthy control (HC) group. First, a systematic review was provided. Second, where data allowed for it, a quantitative meta‐analysis with random effects model was conducted to analyze the differences between the elimination disorder and the HC groups for internalizing and externalizing symptoms. Effect size was standardized mean difference. Meta‐regression analyses were conducted to examine the effect of sex, age, and study quality. Funnel plots were used to detect a publication bias. Where found, the trim and fill method was used to correct it. Results: 36 articles were included, 32 of them reporting on enuresis (n = 3244; mean age = 9.4; SD = 3.4; 43.84% female) and 7 of them on encopresis (n = 214; mean age = 8.6; SD = 2.3; 36.24% female). Children with an elimination disorder presented significantly lower self‐concept (ES:0.42; 95%CI [0.08; 9.76]; p = 0.017) and higher symptom scores for thought problems (ES:−0.26; 95%CI: −0.43;−0.09]; p = 0.003), externalizing symptoms (ES: −0.20; 95%CI [−0.37;−0.03]; p = 0.020), attention problems (ES:−0.37; 95%CI [−0.51;−0.22]; p = 0.0001), aggressive behavior (ES:−0.33; 95%CI [−0.62;−0.04]; p = 0.025) and social problems (ES:−0.39; 95%CI [−0.58;−0.21]; p = 0.0001). Significant publication biases were found across several of the studied domains. No significant effect of sex, age or quality of the study score was found. Conclusions: Children with an elimination disorder may have significant internalizing and externalizing problems, as well as impaired self‐concept. It is recommendable to screen for them in children with enuresis or encopresis and provide appropriate interventions. [ABSTRACT FROM AUTHOR]

Elimination disorders are common in children, and numerous psychosocial treatments for pediatric enuresis and encopresis are available to guide clinicians. However, only five cases of functional elimination disorders in adults are published to date, all of which involve severe comorbid psychopathology, and no treatment guidelines for adult elimination disorders exist. This case report presents, to our knowledge, the first documented case of functional elimination disorder in an otherwise healthy, high-functioning adult. "Ben" is a 20-year-old male who sought treatment for chronic enuresis and encopresis, as well as difficulties with procrastination of schoolwork. Ben engaged in 21 weeks of cognitive behavioral therapy and reported substantial decreases in elimination disorder symptoms. However, improvements fluctuated throughout treatment and remained present at mild levels at 3-month follow-up. This report outlines the cognitive behavioral interventions applied throughout this treatment, which consisted of pediatric elimination disorder interventions adapted for an adult with additional cognitive behavioral tools. [ABSTRACT FROM AUTHOR]

Functional fecal incontinence or encopresis is a condition commonly seen in children, and as such, pediatricians and health care providers who care for children should be familiar with this diagnosis. Encopresis refers to the passage or leakage of feces in inappropriate settings. There is a high prevalence of associated behavioral symptoms in children who have encopresis. Treatment involves patient and family education, behavioral strategies for stool regulation, disimpaction of stool in children who have constipation, and long-term maintenance of regular bowel habits. This discussion reviews the definition, epidemiology, clinical presentation, and treatment of children who have encopresis. [ABSTRACT FROM AUTHOR]

This article describes the course of a psychotherapy with a depressed encopretic boy, using a psychoanalytic approach. The therapy was administered in a public welfare clinic in Israel. Based on an understanding of how the boy's developmental needs had been neglected, an appropriate intervention programme was constructed and implemented. The principal insights determining the course pursued by the psychotherapist included the understanding acquired of the dysfunction and absences within the mother-child relationship during the boy's early years, and the need for the therapist to provide corrective and containing maternal emotional experiences, together with insight regarding the repercussions on the boy's emotional life. Additional understanding was gained about the role of the boy's encopresis, which comprised a symptom, and seemed to be a response to the repressed, unmodulated regressive anger towards the internal maternal figure, owing to the parents' difficulties in meeting the boy's primary developmental needs. [ABSTRACT FROM AUTHOR]

Bladder and bowel dysfunction (BBD) is a common yet underdiagnosed paediatric entity that describes lower urinary tract symptoms (LUTS) accompanied by abnormal bowel patterns manifested as constipation and/or encopresis. LUTS usually manifest as urgency, urinary frequency, incontinence, and urinary tract infections (UTI). Despite increasing recognition of BBD as a risk factor for long-term urinary tract problems including recurrent UTI, vesicoureteral reflux, and renal scarring, the mechanisms underlying BBD have been unclear, and treatment remains empirical. We investigated how constipation affects the lower urinary tract function using a juvenile murine model of functional constipation. Following four days of functional constipation, animals developed LUTS including urinary frequency and detrusor overactivity evaluated by awake cystometry. Physiological examination of detrusor function in vitro using isolated bladder strips, demonstrated a significant increase in spontaneous contractions without affecting contractile force in response to electrical field stimulation, carbachol, and KCl. A significant upregulation of serotonin receptors, Htr2a and Htr2c, was observed in the bladders from mice with constipation, paralleled with augmented spontaneous contractions after pre-incubation of the bladder strips with 0.5 µM of serotonin. These results suggest that constipation induced detrusor overactivity and increased excitatory serotonin receptor activation in the urinary bladder, which contributes to the development of BBD. [ABSTRACT FROM AUTHOR]

Enuresis and encopresis can be stressful for children and parents. We investigated the comorbid psychiatric disorders and the emotional and behavioral symptoms associated with elimination disorders. A total of 97 children and adolescents (aged 4–17 years) with an elimination disorder participated in this study. The elimination disorder group consisted of three subgroups: 50 subjects with enuresis nocturna, 26 with encopresis, and 21 subjects with enuresis + encopresis. The control group with no elimination disorder comprised 50 healthy subjects. All children were interviewed by a child and adolescent psychiatrist. Comorbid psychiatric disorders were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Strengths and Difficulties Questionnaire. The most common diagnosis was attention-deficit/hyperactivity disorder, followed by oppositional defiant disorder. The highest rate of psychiatric comorbidity was observed in the enuresis + encopresis subgroup, followed by the enuresis nocturna and encopresis subgroups. All the subgroups had higher total difficulties scores than the control group. Screening for psychiatric disorders should be performed for all children with incontinence. [ABSTRACT FROM AUTHOR]

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4% covering both enuresis (p = 5.4, 95% CI = 5.1–5.7) and encopresis (p = 0.13, 95% CI = 0.09–0.2). The total prevalence of comorbid disorders was 38%, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p = 11, 95% CI = 9.5–12.7) and Separation Anxiety (p = 10.6, 95% CI = 9.1–12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders. [ABSTRACT FROM AUTHOR]

Although encopresis is a rare disorder that is virtually absent by 16 years of age in children who show normal cognitive function, this condition creates abundant distress for patients and their families. There is a strong relation between encopresis and enuresis, and they share some of the same etiologies and treatment, but they differ in other ways. Information regarding pharmacologic treatment of encopresis remains very limited, and all studies are case reports. Herein, I described a boy with persistent adolescent encopresis and enuresis who was treated principally with imipramine. At the end of our observation period, we were pleased to note a very favorable response regarding encopresis, and a complete response regarding enuresis. We thus wish to supplement the currently available literature in this area with this novel result. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) are often delayed in achieving bowel continence, resulting in negative outcomes. In this pilot trial, 20 children with ASD and encopresis were randomly assigned to multidisciplinary intervention for encopresis (MIE; n = 10) or a waitlist control group (n = 10). The MIE group was treated for constipation and received a 10-day behavioral intervention that utilized suppositories to produce predictable bowel movements that were reinforced. Caregivers were trained to implement the intervention. Results support the feasibility of clinical trials of MIE, with high enrolment, competition, attendance, and caregiver acceptability. Preliminary outcomes were positive, with six of 10 in the MIE group achieving continence by the end of treatment compared to 0 in the control group (p = 0.005). Registered at clinicaltrials.gov (https://clinicaltrials.gov); ID: NCT02383732. [ABSTRACT FROM AUTHOR]

Children who experience enuresis and encopresis can face many difficulties, including social isolation, shame, embarrassment, anxiety, and depression. Due to the prevalence of enuresis and encopresis, it is essential for mental health professionals to understand the common symptoms and available treatment options for enuresis and encopresis, particularly to assist parents struggling to help their children overcome these challenges. Despite this need, there is very little clinical literature that incorporates a systemic approach for families who have a child diagnosed with enuresis and encopresis. Furthermore, common treatment approaches may unwittingly reinforce children's perception that these problems are rooted in their identity. In an effort to address these concerns, the present case study aims to illustrate how a narrative therapy approach was utilized to effectively treat a child with enuresis and encopresis. Narrative therapy can uniquely assist children and their parents by helping them externalize the problem, overcome the problem-saturated view of their lives, and create new experiences where the problem is nonexistent. [ABSTRACT FROM AUTHOR]

Purpose: Severe constipation and encopresis are significant problems in the pediatric population. Medical management succeeds in 50-70%; however, surgical considerations are necessary for the remainder such as the antegrade continence enema (ACE). The purpose of this study is to assess the long-term outcomes following the ACE procedure.Methods: All patients undergoing an ACE over a 14-year period were included. Data on clinical conditions, treatments, and outcomes were collected. A successful outcome was defined as remaining clean with ≤ 1 accident per week. Comparative data were analyzed using the Fisher's exact test, Mann-Whitney U test, or Student's t test.Results: There were 42 ACE patients, and overall, 79% had improvement in their bowel regimens. Encopresis rates decreased from 79 to 5% (P < 0.001). Admissions for cleanouts decreased from 52 to 19% (P = 0.003). All cases of Hirschsprung's, functional constipation and spina bifida were successful. Rates of success varied for other diseases such as slow-transit constipation (60%) and cerebral palsy (33%). A majority (85%) required a change in the enema composition for improvement.Conclusion: In our study, ACE reduced soiling, constipation, and need for fecal disimpaction. Higher volume saline flushes used once a day was the optimal solution and most preferred option.Level Of Evidence: Level 4 (retrospective case series or cohort). [ABSTRACT FROM AUTHOR]

Autism spectrum disorders (ASD) are defined by persistent deficits in reciprocal social interaction, communication, and language, as well as stereotyped and repetitive behavior. Functional incontinence, as well as ASD are common disorders in childhood. The aim of this systematic review was to give an overview of the co-occurrence of nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) in ASD, and vice versa, of ASD in children with incontinence. A systematic literature search of the terms “incontinence”, “enuresis”, and “encopresis” in combination with “autism” or “Asperger” in four databases (Scopus, PubMed, PsycInfo and Web of science) was conducted. All studies that examined incontinence frequencies in samples with ASD, and studies that measured frequencies of ASD diagnoses or symptoms in samples with incontinence were included. Risk of bias and limitations of each study were described. After eligibility assessment, 33 publications were included in the review. The published literature implies a higher prevalence of incontinence in children with ASD compared to typically developing children. Limitations and biases as inappropriate diagnostic criteria for ASD and incontinence, selected samples, or lack of control groups are reported. Associations of incontinence in ASD with psychopathological symptoms were found. Vice versa, ASD symptoms are found in incontinent children, but no study included a non-ASD control sample. Incontinence symptoms are also reported as an adverse effect of medication in ASD. Due to methodological problems and definitional discrepancies in some publications, results have to be interpreted cautiously. Research in ASD and incontinence is scarce. More systematic research including state-of-the-art assessments is needed. [ABSTRACT FROM AUTHOR]

The current study investigated toileting problems in one hundred and twenty-seven children and adolescents with parent-reported diagnoses of autism spectrum disorder. Toileting refers to the accomplishment of various unprompted behaviors, including recognising the need to go to the toilet, and waiting before eliminating. The relationship between toileting problems and age, gender, intellectual disability, gastrointestinal symptoms, sleep problems, comorbid psychopathology, quality of life, and adaptive functioning were examined using parent-report questionnaires. The most common toileting problems were, “Does not independently perform most self-help tasks”, “Has toilet accidents during the day”, and “Parent/caregiver notices smears in underwear”. Gender, presence of intellectual disability, gastrointestinal symptoms, and comorbid psychopathology were significant predictors of toileting problems in this study. The gastrointestinal symptoms of constipation and bloating were found to be significant predictors of toileting difficulties. Specifically, constipation predicted accidents and physical problems associated with toileting, and bloating predicted social/emotional factors and physical problems. A small negative correlation was observed between total toileting problems and total health related quality of life. An increase in physical toileting difficulties was associated with lower quality of life. [ABSTRACT FROM AUTHOR]

Aim: To describe the prevalence and consultation characteristics of enuresis in Australian paediatric practice and assess for changes over a period of 5 years.Methods: Data collected prospectively by paediatricians (outpatient settings) in 2008 and 2013, as part of the Children Attending Paediatricians Study. Consultations on children aged 5 years or over were included. Consultations in each cohort (2008 and 2013) categorised as either listing or not listing enuresis. Characteristics of the 'enuresis' versus 'non-enuresis' subgroup in each cohort were compared as were the enuresis subgroups 2008 versus 2013.Results: Of 4175 and 4181 consultations in 2008 and 2013, enuresis was reported in 178 (4.3% - 2008) and 193 (4.6% - 2013). Constipation and encopresis were more prevalent in the enuresis versus non-enuresis subgroups (46 (25.8%) vs. 136 (3.4%) for constipation and 25 (14%) vs. 65 (1.6%) for encopresis in 2008; 52 (26.9%) vs. 160 (4%) for constipation and 25 (13%) vs. 78 (2%) for encopresis in 2013, both P < 0.001). The enuresis subgroup had more referrals to multidisciplinary teams (19 (10.7%) vs. 148 (3.7%) - 2008 and 21 (10.9%) vs. 163 (4.1%) - 2013, both P < 0.001) and allied health professionals (29 (16.3%) vs. 230 (5.8%) - 2008; 27 (14%) vs. 178 (4.5%) - 2013, both P < 0.001).Conclusion: The overall frequency of presentation of children for management of enuresis was low. Prevalence/Consultation characteristics of enuresis were comparable over 5 years. Constipation and encopresis were significantly more prevalent in the enuresis subgroups. [ABSTRACT FROM AUTHOR]

The term 'encopresis', derived from ancient Greek ἐγκόπρησις / egkóprēsis, which means stool, was fi rst introduced in 1926 by Weissenberg to describe the loss of stool in underwear as the faecal equivalent of enuresis. The soiling of underwear is defined as the accidental passage of very small amounts of faeces into underpants. Quantitatively, the content of stool between encopresis and soiling is difficult to determine, and it is especially difficult for parents assess it. Therefore, a new term was adopted - faecal incontinence - that encompasses both encopresis and soiling. Faecal incontinence is defined as the discharge of faeces in socially awkward situations at least once per month in children ≥ 4 years old. In approximately 95% of cases, faecal incontinence in children is not organic in origin, but instead appears as a functional gastrointestinal disorder. In 80% of children with functional faecal incontinence, the symptoms are associated with functional constipation. The remaining 20% of the cases involve no signs of faecal retention and are defined as non-retentive functional faecal incontinence. This paper aims to present the latest fi ndings within this area of paediatric gastroenterology. [ABSTRACT FROM AUTHOR]

Achieving continence of one's bowel movements is a key step in development and failure to do so leads to many negative consequences. Treatments for encopresis appearing in the literature have employed behavioral strategies; medications such as suppositories, laxatives, or enemas; and in some studies a combination of these approaches. To date, attempts to extend successful treatments for encopresis in typically developing children to those with developmental disabilities have been limited. The current study included three participants diagnosed with developmental disabilities who had a history of encopresis. None of the participants had a continent bowel movement under baseline conditions. Continent bowel movements increased during treatment that included the addition of suppositories to elicit continent bowel movements. Two participants began having independent continent bowel movements (i.e., without requiring suppositories) and medication was successfully faded out for the remaining participant. Treatment took between 13 and 21 days. [ABSTRACT FROM AUTHOR]

Recommendations for clinical practice in health is usually based on a cumbersome methodology. It involves the creation of a steering group and one or more working groups. It also involves both editors and a reading group to try to answer questions deemed relevant in terms of care and treatment. The project requires a systematic analysis of the literature and the drafting ofrecommendations whose level of proof must be graded. A short and a long text are usually submitted to be validated by the reading group and then to an audience involved in the management of the disease. This is a long-term process: a two-year period usually separates the implementation of the project from the first communication. Under the aegis of the SNFCP and in partnership with the SNFGE and the GFNG, recommendations for the treatment of constipation now rest on the work of analyzing the literature and drafting of 33 courageous partners who are here thanked. A rapid speculation would suggest that the process is over. It remains two important steps : the first is the diffusion of recommendations and the second is its dissemination. Recommendations for clinical practice are usually targeted to the greatest number of practitioners. Classically the short text is readily available with a willingness to disseminate it to general practitioners and nursing staff: it is available on the sites of the three partner societies. The long text develops a detailed argument that often falls within the domain of expertise and specialty. The communication of the ranks of recommendations during congress or publication remains unfortunately often an insufficient stage in their dissemination. The text is difficult to read and it is not often of great help in daily practice. This observation led several societies to abandon these large works at limited impact. We chose this time the elaboration of argued algorithms, representing an aid to the therapeutic decision in the most common situations. These algorithms have been developed independently of the drafting of the short text of the recommendations but they are based on the same methodology. The different steps of each algorithm are documented by a short text, grades of recommendations and essential references. Their main objective is to improve the penetration of available scientific data into practice. [ABSTRACT FROM AUTHOR]

Aim Overlapping anal sphincter repair (OASR) is used for treatment of faecal incontinence due to an external anal sphincter (EAS) defect; however, it is not the optimal treatment as its functional results tend to deteriorate significantly with time. The present study aimed to evaluate the effect of local injection of bone marrow aspirate concentrate (BMAC) on the outcome of OASR. Method We compared a prospective group of 20 patients with EAS defect who were managed with OASR and BMAC injection (group I) with a historical control group of an equal number of patients managed with OASR alone (group II). Patients were assessed preoperatively and during follow-up by the Wexner continence score and endoanal ultrasound. The primary end-points were the improvement of the continence level measured by the Wexner score and the residual EAS defect size measured by endoanal ultrasound. Results At the end of follow-up, group I had significantly lower mean postoperative Wexner score (5.4 ± 7.6 vs 10.6 ± 7.4; P = 0.03) and smaller EAS defect percentage (12.2 ± 17.5 vs 18.3 ± 18.9). These findings were statistically significant in patients with a small preoperative EAS defect equal to or less than one-third of the anal circumference. Patients with larger preoperative EAS did not show a significant improvement of the continence level after repair in either group. Conclusion Augmenting OASR with local injection of BMAC in patients with faecal incontinence caused by an EAS defect, particularly a smaller defect, can improve both functional and anatomical outcomes of OASR. [ABSTRACT FROM AUTHOR]

Functional constipation is an issue for both the patient and his/her family, affecting the patient’s psychoemotional balance, social relations, and their harmonious integration in the school environment. We aimed to highlight the connection between chronic constipation and encopresis and the patient’s psychosocial and family-related situation. Material and Method. 57 patients with ages spanning from 6 to 15 were assessed within the pediatric gastroenterology ward. Sociodemographic, medical, and psychological data was recorded. The collected data was processed using the SPSS 20 software. Results. The study group consisted of 57 children diagnosed with encopresis (43 boys (75.44%) and 14 girls (24.56%)), M=10.82 years. It was determined that most of the children came from urban families with a poor socioeducational status. We identified a level of studies of 11.23±5.56 years in mothers, while fathers had an average number of 9.35±4.53 years of study. We also found a complex relationship between encopretic episodes and school performances (F=7.968, p=0.001, 95% Cl). Children with encopresis were found to have more anxiety/depression symptoms, greater social problems, more disruptive behavior, and poorer school performance. Conclusions. The study highlights the importance of the family environment and socioeconomic factors in manifestations of chronic constipation and encopresis. [ABSTRACT FROM AUTHOR]

Purpose: Each ethnic group has a unique life style, including diets. Life style affects bowel movement. The aim of this study is to describe the results of colon transit time (CTT) tests in Korean children who had chronic functional constipation based on highly refined data. Methods: One hundred ninety (86 males) out of 415 children who performed a CTT test under the diagnosis of chronic constipation according to Rome III criteria at Konkuk University Medical Center from January 2006 through March 2015 were enrolled in this study. Two hundreds twenty-five children were excluded on the basis of CTT test result, defecation diary, and clinical setting. Shapiro-Wilk and Mann-Whitney U, and chi-square tests were used for statistical analysis. Results: The median value and interquartile range (IQR) of CTT was 54 (37.5) hours in Encopresis group, and those in non-encopresis group was 40.2 (27.9) hours (p<0.001). The frequency of subtype between non-encopresis group and encopresis was statistically significant (p=0.002). The non-encopresis group (n=154, 81.1%) was divided into normal transit subgroup (n=84, 54.5%; median value and IQR of CTT=26.4 [9.6] hours), outlet obstruction subgroup (n=18, 11.7%; 62.4 [15.6] hours), and slow transit subgroup (n=52, 33.8%; 54.6 [21.0] hours]. The encopresis group (n=36, 18.9%) was divided into normal transit subgroup (n=8, 22.2%; median value and IQR of CTT=32.4 [9.9] hours), outlet obstruction subgroup (n=8, 22.2%; 67.8 [34.8] hours), and slow transit subgroup (n=20, 55.6%; 59.4 [62.7] hours). Conclusion: This study provided the basic pattern and value of the CTT test in Korean children with chronic constipation. [ABSTRACT FROM AUTHOR]

Chronic constipation is an extremely common and costly condition that can negatively impact the patient's quality of life, resulting in a major economic and social burden. Most patients do not understand their situation and suffer from social isolation. The developmental particularities of the child cause the etiology and symptomatology of constipation to differ from those described by adults, which requires a specific management in terms of diagnosis and treatment. The specialty literature to date relies on fragmented studies focused on these particularities, as well as on the multitude of aspects of diagnostic and treatment related to chronic stool retention and bowel evacuation in children. The problem that is being studied is important not only from a medical and socioeconomic point of view, but also because some complications caused by chronic constipation (such as encopresis and enuresis) lead to the social isolation and physical and psycho-emotional impairment of these children. [ABSTRACT FROM AUTHOR]

Constipation is a common problem in childhood, with a children prevalence varying between 0.7% and 29.6%. Constipation is encountered in all pediatric age groups, with variably severity and duration, from mild and short to severe and chronic forms, with faecal impact and encopresis. This article review the epidemiological, clinical and therapeutically aspects of children constipation, functional in the majority of cases. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 14-year-old girl who was diagnosed with encopresis after her exposure to school bullying in Istanbul, Turkey. Topics discussed include the behavioral background of the child before and after the diagnosis of the complete encopresis, the treatment and outcome of the patient's condition, and the risk of mental health problems in children who became victims of bullying.

Psychologists often come across the issues of enuresis (bedwetting) and encopresis (involuntary defecation) in practice and, therefore, it may be assumed that they will welcome a thesis on this topic. The aim of the research was to analyse and describe the influence of summer camp ("SC") rehabilitation stays for children suffering from enuresis and encopresis on their diseases. The author collected data via interviews, observation, and document analysis. The cooperating psychologists contributed to the methodology with outcomes of psychological assessment. The sample included 10 children aged 7 to 13, suffering from enuresis; in case of two children encopresis was also referred. Parents of these children as well as specialists (psychologists, paediatricians and nephrologists) were also addressed. The results of the research showed that the SCs contribute to the improvement of a psychosocial situation of children suffering from enuresis and encopresis. Furthermore they also positively influence the frequency of bedwetting and soiling. [ABSTRACT FROM AUTHOR]

Studies have shown that encopresis, related to bowel control disorder, can bring significant impact for the individual life, such as low self-esteem and deficits in social interaction. Despite the significant impairment recognized that this disorder can have on child development, the scientific literature has given little attention to the theme, with a low number of publications on the subject. Thus, this paper investigated Brazilian publications in psychology related to encopresis between 1994 and 2013 in data base Lilacs and Scielo. 231 articles were found and were selected those that reported only intervention in encopresis. There were five articles and four published by the same journal and described behavioral interventions, and one author wrote three. The other one was psychoanalytic. The surveys were conducted with children and adolescents and behavioral interventions have been successful with remission of encopresis symptoms. The data affirm the deficiency in publications in the area and possibly limited number of psychologists investigating the issue, which is of significant importance. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to assess maternal psychiatric symptoms, family functioning and parenting styles in children with encopresis. Methods Forty-one children with encopresis were compared to 29 children without any psychiatric disorder. Results Higher maternal psychiatric symptoms were found in children with encopresis. The general family functioning and strictness/supervision in parenting were significant predictors of encopresis. Conclusions Family functioning may be screened in children with encopresis, especially when standard interventions have had limited success. Identification and treatment of familial factors may enhance the treatment efficacy in encopresis. [ABSTRACT FROM AUTHOR]

In the last decade constipation has become a current problem addressed in the pediatric gastroenterology departments. Objectives. We propose a study to establish the prevalence of constipation and the correlations between diet and the socio-familial environment in children aged from 1 to 17 years old, hospitalized in the Gastroenterology Department, „Saint Mary“ Emergency Hospital for Children of Iasi, between 1 January 2012 and 1 January 2014 Results. The study group consisted of 994 patients, representing 9.6% of all hospitalized children. Regarding the prevalence of constipation, we did not notice a significant difference between the sexes, the ratio F/M was 1.3/1, but we found a significantly higher proportion of patients from urban areas 68% (676) versus 32% (318) from rural areas. In terms of social and family environment: 34% (338) of children live with grandparents, 13.9% (139) come from single-parent families, 6.7% (67) are in the care of a foster parent and 2.6% (26) come from orphanages. In the group studied a low percentage of children were breastfeed, respectively 26.2% (261) in the first month, 10.7% (107) for 3 months, while at 6 months 98.1% (976) of children received a milk formula. Diversification was done incorrectly in the case of 41% (408) patients. Only 14.6% (145) reported daily consumption of fruits and vegetables, while 51.1% (508) had dinner at least once a week at fast food restaurants. 21.6% (214) practice sport at least 2 hours/week, while 48.7% (484) spend at least 3 hours/day watching television. 12.8% (128) of patients are overweight and 5.7% (57) obese. Conclusions. Constipation is a condition that affects children of all ages. There are not notable differences between the sexes. An increased proportion of urban patients with predominance of inadequate diet, physical inactivity and an increased proportion of overweight patients was found. The socio-familial environment has an important role in the psychological changes. [ABSTRACT FROM AUTHOR]

Chronic functional constipation with or without encopresis is a common problem in the pediatric population, and the prevalence of encopresis may be underestimated. The aim of this study was to assess the prevalence and risk factors for overflow incontinence in patients with chronic constipation seen at a pediatric gastroenterology consultation. A retrospective study of 270 files of patients seen between 1997 and 2012 was conducted, and a classification according to Rome III criteria was done. Among 145 (53.7%) boys and 125 (46.2%) girls, 117 had overflow incontinence (43.3%) - 41 (35%) girls and 76 (65%) boys. The first symptoms of chronic constipation appeared at a median age of 30 and 33 months in encopretic and 16 and 12 months in nonencopretic girls and boys, respectively. The first specialized consultation took place after a median disease duration of 26.5 and 24 months in encopretic and 16 and 9 months in nonencopretic girls and boys, respectively. A history of stool retention and the presence of scybala at examination, but not of pain at defecation or anal fissure, were associated with encopresis. The onset of chronic constipation after the age of 2 years, a longer disease duration, male gender, and a history of stool retention were seen as risk factors for the development of encopresis in patients with chronic functional constipation. [ABSTRACT FROM PUBLISHER]

Based on clinical experience, we hypothesized that rigid-compulsive behaviors are associated with severe constipation and co-occurring diarrhea or underwear staining in children with autism spectrum disorder. Using data from the Autism Treatment Network, we evaluated the association between these gastrointestinal symptoms and measures of rigid compulsive behavior in children ages 2-17. Following statistical correction, four of five primary measures were significantly associated with constipation and diarrhea or underwear staining, including parental report of repetitive behavior, parental report of compulsive behavior, clinician diagnosis of obsessive-compulsive disorder, and report of rituals observed on the autism diagnostic observation schedule. This association could point to a causal connection between these symptoms or to a common biological pathway that impacts both gut and brain. [ABSTRACT FROM AUTHOR]

Background: According to the Rome III criteria, encopresis without constipation was defined as nonretentive fecal soiling (FNRFS) with not yet well understood etiology. Treatment approaches reported in the literature with varying results include biofeedback, hypnosis, reflexology, and Internet-based educational programs. In developmental age, another behavioral treatment could be identified in the psychomotor approach, which is called psychomotricity in the European countries, or is also known as play therapy. The aim of the present study was to verify the safety and efficacy of play therapy plus toilet training in a small sample of prepubertal children affected by FNRFS. Materials and methods: Twenty-six patients (group 1; 16 males, mean age of 5.92 ± 0.84 years) underwent a psychomotor approach therapy program in association with toilet training for 6 months, and the other 26 subjects (group 2; 17 males, mean age of 5.76 ± 0.69) underwent the sole toilet training program for 6 months. During the observational time period (T0) and after 6 months (T1) of both treatments, the patients were evaluated for FNRFS frequency and for the behavioral assessment. Results: At T0, the FNRFS mean frequency per month for group 1 was 20.115 episodes/month (standard deviation [SD] ± 3.024) and for group 2 was 20.423 (SD ± 1.879) (P = 0.661). At T1 the mean frequency per month was 6.461 (SD ± 1.333) episodes/month and 12.038 (SD ± 1.341), respectively (P < 0.001). Moreover, the delta percent average of the frequency between T0 and T1 was 67.121 ± 8.527 for group 1 and 40.518 ± 9.259 for group 2 (P < 0.001). At T1, a significant improvement in scores on the behavioral scale was identified. Conclusion: Our preliminary results show the importance of a multidisciplinary approach, and suggest the positive effect of an additional psychomotor approach, as this holds a new and interesting rehabilitative purpose for children in a toilet training program, even if further research is necessary. [ABSTRACT FROM AUTHOR]

Elimination disorders are very common in children: 10 % of 7-year-olds wet at night (nocturnal enuresis), 2-3 % during daytime (diurnal urinary incontinence) and 1-3 % soil (faecal incontinence). In the past decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies, comorbid disorders and specific treatment options. The aim of the paper is to present a short overview of the proposed DSM-5, the ICCS and the Rome-III classification systems, of assessment and of treatment. The DSM-5 criteria no longer reflect current research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. Assessment of most elimination disorders can be performed in paediatric and child psychiatric primary care settings. The standard assessment consists of a thorough history, frequency/volume charts, specific questionnaires, a full physical examination, sonography and urinalysis. If possible, a child psychiatric assessment is performed. In all other settings, screening with a validated behavioural questionnaire and referral if indicated is recommended. All other investigations are indicated only in complicated cases and if an organic cause is to be ruled out. Treatment is symptom oriented and based on the exact diagnosis of the type of elimination disorder. Counselling is recommended in every case. Most elimination disorders can be treated by specific treatment programmes integrating cognitive-behavioural elements. Nocturnal enuresis is best treated with alarms. Medication can be indicated in nocturnal enuresis (desmopressin), urge incontinence (anticholinergics such as oxybutynin, propiverine, etc.) and faecal incontinence with constipation (polyethylene glycol). Comorbid behavioural and emotional disorders require additional treatment. [ABSTRACT FROM AUTHOR]

This paper attempts to convey how the ideas of Klein, Bion and Bick underpin psychoanalytically based interventions with parents, babies and young children in the Camden Under Fives' Service, Tavistock Clinic. As the title suggests, my focus is on ways in which anxiety relating to separation and loss, can be contained through the transformative function of ‘reverie’. I describe two clinical examples, of a bereaved couple who lost their baby at six weeks and of a three-year-old child suffering from severe constipation, to explore the role of therapeutic work in facilitating a shift away from a defensive ‘holding onto’ a concrete object as a means of evading separation, towards a more symbolic level of functioning, feeling ‘held in mind’. Steiner's description of the mourning process moving along a continuum from ‘fear of the loss of the object’ towards ‘experience of loss of the object’ as the patient shifts away from the ‘paranoid–schizoid’ towards a more ‘depressive position’ and the successful completion of mourning, is linked to Bion's concept of container-contained. The role of the clinician as ‘container’ of unprocessed states in young children, is discussed and linked to the recognition of ‘turning points’ in brief and longer-term work with under fives. [ABSTRACT FROM PUBLISHER]

Aim: The aim of this study was to assess behavioral problems in children with encopresis as well as anxiety levels of the mothers and marital problems of the parents. Material and Method: The case group included 31 boys with encopresis and their mothers; the control group included 26 boys who did not have chronic disease and their mothers. Child Behavior Checklist (CBCL), State Trait Anxiety Inventory (STAI-II) and Marital Conflict Questionnaire (MCQ) were used. The mean scores of the scales of the two groups were compared by Mann-Whitney U test the study approved by the ethics committe of Cerrahpasa Medical Faculty. Results: CBCL total problem scores, externalization, aggressive behavior, delinquent behavior and attention problem scores were significantly higher; CBCL competency total scores and school scores were significantly lower in the case group. In addition, MCQ scores were significantly higher in the encopresis group. Maternal STAI-II scores did not differ significantly between the groups. Conclusions: Attention and behavior problems may be the target of interventions for treatment of encopresis in children. Treatment of these problems may increase treatment compliance and prevent conflicts that may occur within the family in relation to these problems. Addressing severe marital problems that may be a source of distress and worsening factor for treatment may contribute to the treatment of these children. [ABSTRACT FROM AUTHOR]

Constipation is a common childhood problem, with both somatic and psychological effects. The etiology of paediatric constipation is likely multifactorial, and seldom due to organic pathology. Children benefit from prompt and thorough management of this disorder. The goal of treatment is to produce soft, painless stools and to prevent reaccumulation of feces. Education, behavioural modification, daily maintenance stool softeners and dietary modification are all important components of therapy. Fecal disimpaction may be necessary at the outset of treatment. Investigations are rarely necessary. Polyethylene glycol is a safe, effective and well-tolerated long-term treatment for constipation. Regular follow-up for children with constipation is important. Referral to a gastroenterologist should be made in refractory cases or when there is a suspicion of organic pathology. [ABSTRACT FROM AUTHOR]

Objective: Information about the relationship between encopresis and parental and familial features is very limited. In addition, only a limited number of studies have examined the psychopathology of children with encopresis. In this study, we aimed to investigate the familial and parental features and also the comorbid psychopathology of children with encopresis. Method: Thirty patients with a diagnosis of encopresis and 30 healthy controls were included in the study. The Family Assessment Device (FAD), the Temperament and Character Inventory (TCI) and the Symptom Check List (SCL-90-R) were administered to parents. Psychiatric diagnoses of the children were determined using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Lifetime Version (Kiddie-SADS-PL). Results: In all dimensions of the FAD, parents of the patients indicated worse family functioning compared to controls. Scores of the SCL-90-R did not reveal any significant difference between the two groups. According to the TCI, mothers of the patients scored lower on cooperativeness and compassion measures, and fathers of the patients scored lower on cooperativeness, empathy, self-transcendence, and transpersonal identification measures. Fathers of the patients also scored higher on impulsiveness and shyness measures. The children with encopresis had higher rates of comorbid oppositional defiant disorder according to the Kiddie-SADS-PL. Conclusion: This study indicates that impaired family functioning, particularly personality traits of the parents, may play an important role in the etiology or persistence of encopresis and that some other psychiatric conditions may accompany this disorder in children. [ABSTRACT FROM AUTHOR]

Comorbidity of Attention Deficit Hyperactivity Disorder (ADHD) with other psychiatric disorders is a common condition and frequently causes difficulties in treatment. Also comorbidity of ADHD and encopresis is known to be common. Despite behavioral methods are known to be effective in treatment of encopresis, some psychotropic drugs are stated to be effective in treatment of encopresis in the literature. However, the mechanisms of these drugs in treatment of encopretic symptoms are not known exactly. In this article two boys are presented who admitted to a Child Psychiatry clinic with complains of gaita incontinence and overactivity. After clinical assessment, these boys were diagnosed as encopresis and ADHD. Firstly, short acting methylphenidate medication was administered to the patients, however, because of need for single dose medication, short acting methylphenidate treatment was switched to the extended release methylphenidate in both patients. Despite encopresis symptoms did not change with short acting methylphenidate, these symptoms disappeared with extended release methylphenidate treatment and did not recur during four and fifteen months of follow-up. The cases are presented and possible mechanisms of ADHD-encopresis comorbidity and possible mechanisms of effect of extended release methylphenidate on encopresis are discussed in this article. As a conclusion, searching and treating ADHD symptoms may lead to recovery of encopretic symptoms in patients with ADHD and comorbid encopresis. [ABSTRACT FROM AUTHOR]

Elimination disorders are common in childhood and adolescence. Enuresis is defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards-after excluding organic causes. In the past few decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies and specific treatment options. The DSM-IV criteria no longer reflect this wealth of research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. These are presented and discussed. Integration of these into DSM-5 is highly recommended. [ABSTRACT FROM AUTHOR]

Abstract: A lack of toileting skills is one of many impairments that individuals with intellectual and developmental disabilities experience. Unfortunately, little research has focused on problems in this area including assessment, function, and treatment. A newly developed checklist, the Profile of Toileting Issues (POTI), is being considered for use to screen for toileting issues in this population, and to identify potential functions to target in treatment. The purpose of the current study was to examine the reliability of the POTI. Internal consistency was sound (α =.83) and interrater reliability was significant. The implications of these findings are included. [ABSTRACT FROM AUTHOR]

Abstract: Our aim was to assess the potential of Escherichia coli O157:H7 to persist in a processing environment. We studied E. coli behaviour under conditions modelling those of meat plants to establish one initial bacterial load that allows persistence and another that does not. Polyurethane coupons (3.5cm2) were contaminated once with E. coli in meat exudate before being subjected daily to a cleaning product and a disinfectant, both at half the recommended in-use concentrations, and a further soiling with the exudate. This procedure aimed to model what occurs in harbourage sites. Because previous experiments showed that persistence could not be achieved at 15°C (temperature of slaughter halls), we incubated the coupons at 20°C. Viable cells were determined by ethidium monoazide-qPCR (EMA-qPCR). When the first chemical treatment (CT) was applied to 24-hour biofilms with 5.4logCFU/cm2, cells were no longer detectable after the first week. However, on 66-hour biofilms with 6.7log CFU/cm2, after initially decreasing, E. coli numbers reached 6.6logCFU/cm2 and 8.3logviable cells/cm2 on the 11th day. When E. coli was cultured with a Comamonas testosteroni previously shown to increase E. coli biofilm formation, and subjected to CT on alternate days, E. coli stabilized at 4.6logCFU/cm2 before the CT, from the 5th day of the experiment. The killing and detachment effects of the CT decreased over time and PCR quantification detected a resumption of growth after 2days (CT on alternate days) or 3days (daily CT). Intracellular pH (pHi) of individual cells was determined during an experiment in which the CT was applied on alternate days. The proportion of cells with no proton gradient towards the environment (pHi≤5.4) increased after the CT as expected. But during the first week of the experiment only, a further increase in this proportion occurred 24h after the CT, suggesting that some of the surviving viable but non-culturable cells finally died. This study shows that conditions leading to E. coli O157:H7 persistence are not likely to arise when good refrigeration and hygiene practices are applied, and highlights the usefulness of EMA or PMA-qPCR as a complement to CFU determination in studying bacterial survival after cleaning and disinfection. [Copyright &y& Elsevier]

Objective: Data about sociodemographic features, enuresis type, etiological types, family history, copying strategies, and approach to drug therapy of families towards enuresis, comorbid disorders, conducted treatment modalities are aimed to inquire in this study. Method: Data of 61 patients, who admitted to our policlinic and had enuresis nocturna with this diagnosis September 2007 to June 2008, were screened. Findings: Of the subjects, 57.4% were males and 42.6% were females. Most of the cases (63.9%) were observed at 5-10 years of age while 36.1% occurred 11-16 years of age. Positive family history was found in 78.7% of children with enuresis. In the history deep sleep and difficulty in awakening is obtained in 60.7% of the children with enuresis. In 37.7% of cases stressor factors accomEtpany enuresis. Primary enuresis was seen in 70.5% of cases. There was another accompanying psychiatric disorder in 72.1% of enuresis nocturna cases; the most common concomitant disorder was encopresis (27.9%). The other frequent disorders are mental retardation (19.7%), attention deficit hyperactivity disorder (18%), and enuresis diurna (18%) respectively. It was determined that behavioral treatment had been used in 93.4% of cases. Discussion and Conclusion: All of the families were determined to take prevention against enuresis. Presence of significantly high stress in secondary enuresis implies need to assessment of psychosocial factors in etiopathogenesis. Enuresis nocturna must be treated, as it is a disease that can result in low self-esteem, and some secondary psychological problems. It is necessary to inform the parents wherever they are met, especially at primary health care settings. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to present the clinical features of children with encopresis, their comorbid psychiatric disorders, the relation between types of encopresis and comorbid psychiatric disorders and the relation between the suggested treatment type and continuation of treatment. Method: The study population consisted of children who were older than 4 years and referred to the Karadeniz Technical University Faculty of Medicine, Department of Child and Adolescent Psychiatry Clinic with soiling, between July 2005 and June 2007. Clinical charts of patients with fecal soiling were examined retrospectively. Findings: Of a group of children who were referred to our department with a complaint of soiling, 107 [83 boys, 24 girls] were found to fulfill the diagnostic criteria for encopresis according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Of the 107 participants, 22 [20.6%] had primary encopresis and 85 [79.4%] had secondary encopresis. 74 [69.2%] of the patients met the criteria for at least one comorbid disorder. The patients with secondary encopresis had a significantly higher rate of comorbidity [p=0.039]. Behavioral treatment was provided to 44.9% of the patients, psychopharmacologic treatment was given to 18.7% and a combined treatment was provided to 36.4% of the patients. Discussion and Conclusion: Encopresis is a disruptive impairment that may affect a child's social, emotional, and educational development. Encopresis is frequently accompanied by a psychiatric disorder. This study shows significantly high rates of behavioral and emotional problems in children who soil. Clinicians need to inquire about symptoms of other psychiatric disorders in patients who present with encopresis. [ABSTRACT FROM AUTHOR]

Abstract: Children and adults with developmental disabilities are more likely to evince encopresis, soiling and constipation than the general population. This set of related behaviors can produce a great deal of stress and can be a major restriction in independent living. This paper provides a review of the current state of knowledge on the prevalence, etiology, assessment and treatment of this co-occurring set of disorders. These problems are more common in persons with developmental disabilities then the general population. Furthermore, classical and operant treatment methods appear to be the best supported interventions for most cases. Strengths and weaknesses of the current research base are discussed along with potential avenues for future research. [Copyright &y& Elsevier]

Summary: Gastrointestinal symptoms are very frequent in myotonic dystrophy but largely unrecognized. They can be the revealing factors of the disease. We report 2 cases of 10 and 17-year-old children with persistent encopresis starting at the age of 3 and 5 years in spite of laxative treatment. Neurological examination and anorectal manometry provided the diagnosis of myotonic dystrophy. Procainamide treatment was introduced and the digestive symptoms improved. Any child with encopresis should have complete evaluation to rule out the diagnosis of myotonic dystrophy and physicians should look for upper and/or lower gastrointestinal symptoms in every patient with myotonic dystrophy. [Copyright &y& Elsevier]

Aim: To identify risk factors for urinary tract infection (UTI) in children to inform the development of preventative strategies. Method: A validated questionnaire covering demographic factors, perinatal, developmental, bowel and urinary history was sent to a cross-sectional sample of parents of elementary school children randomly selected from the first 4 years of school. UTI was ascertained by parental report, verified by cross-referencing with microbiological reports for all positive cases and 50 randomly selected negative cases. Results: Parents of 2856 children (mean age 7.3 years, range 4.8–12.8 years) responded. A total of 3.6% of children had a bacteriologically verified UTI, compared with 12.6% by parental report alone. Multivariate polychotomous logistic regression showed that a history of structural kidney abnormalities (odds ratio (OR) 15.7, 95% confidence interval 8.1–30.4), daytime incontinence (OR 2.6, 1.6–4.5), female gender (OR 2.4, 1.5–3.8), and encopresis (OR 1.9, 1.1–3.4) were independently associated with UTI. Daytime incontinence increased risk more in boys (8.3% vs. 1.2%) than girls (8.1% vs. 4.6%), and kidney problems increased risk in older compared with younger children (29% vs. 2% in ≥8 year olds, 0% vs. 4% in 4–6 year olds). Conclusions: Parents over-report UTI by about threefold. Effective treatment of daytime urinary incontinence and encopresis may prevent UTI in children, especially boys. [ABSTRACT FROM AUTHOR]

Objectives To assess the outcome of patients presenting with functional constipation in childhood during a 10-year period and to determine any risk factors for developing persistent constipation throughout adolescence and adulthood. Patients and Methods 72 children (mean age 4 years; 40 boys) referred for constipation were included in a longitudinal set of observations. Initial workup included segmental colonic transit time and anorectal manometry; 45 of the 72 patients could be reevaluated 10 to 12 years later. Results 21 of 45 patients (46%; 95% confidence interval 29% to 67%) remained constipated at follow-up. Encopresis and recurrent abdominal pain were present in 25% and 56% of patients, respectively. Patients with anorectal dyssynergia remained more frequently constipated at follow-up than the others: 61% versus 29% (P < .05). Conclusion Almost 50% of patients presenting with constipation during childhood remained constipated on long-term follow-up. Anorectal dyssynergia is associated with a worse prognosis. [ABSTRACT FROM AUTHOR]

Abstract: We report two new patients with the 1.4Mb recurrent 22q11.2 distal deletion syndrome. Features common to both children, as well as to several of the previously reported cases, include normal palate, smooth philtrum, hypoplastic alae nasi and delayed development. Both children are small but not growth retarded, and are microcephalic. Their developmental delay is global and most pronounced for language acquisition. One child has unilateral sensorineural hearing loss and encopresis, and the other child has treatment-responsive nocturnal epileptogenic activity. These two new cases confirm the recurrent nature of the deletion and help to further delineate the phenotype. [Copyright &y& Elsevier]

To date, due to the increasing prevalence of psychiatric diseases, the use of antipsychotic drugs has expanded. One of the proven side effects of these drugs is incontinence. Treatment of this complication improves the quality of life in these patients, increases self-confidence, and betters cope with their psychiatric illness. The exact mechanism of this side effect is not fully understood, but various methods have been used experimentally to deal with it. Strategies such as behavior therapy, discontinuation or change of drugs, reducing the dose of drugs, and adding drugs with less incontinence have been used. Each of these methods and studies has different results that need to be summarized to make optimal use of them. Since most of these reports are case reports with a low statistical population, our study has systematically reviewed these studies to find a comprehensive model to deal with this complication. [ABSTRACT FROM AUTHOR]