Detailed Search Results
| Author/Association: | van Dijk M, Bongers ME, de Vries GJ, Grootenhuis MA, Last BF, Benninga MA |
| Title: | Behavioral therapy for childhood constipation: a randomized, controlled trial [with consumer summary] |
| Source: | Pediatrics 2008 May;121(5):e1334-e1341 |
| Method: | clinical trial |
| Method Score: | 7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
| Consumer Summary: | WHATS KNOWN ON THIS SUBJECT: Stool-withholding behavior is probably the major cause for development and/or persistence of childhood constipation. There is some evidence that the adjunct of behavioural interventions to laxative therapy, rather than laxative therapy alone, improves continence in children with constipation. WHAT THIS STUDY ADDS: This is the first large, randomized, controlled trial evaluating the effectiveness of behavioural therapy in constipated children. The study showed that conventional treatment should remain the first choice of treatment. When behavioral problems are present, behavioral therapy should be considered. |
| Abstract: | OBJECTIVE: It has been suggested that the addition of behavioral interventions to laxative therapy improves continence in children with functional fecal incontinence associated with constipation. Our aim was to evaluate the clinical effectiveness of behavioral therapy with laxatives compared with conventional treatment in treating functional constipation in childhood. PATIENTS AND METHODS: In this randomized, controlled trial conducted in a tertiary hospital in The Netherlands, 134 children aged 4 to 18 years with functional constipation were randomly assigned to 22 weeks (12 visits) of either behavioral therapy or conventional treatment. Primary outcomes were defecation frequency, fecal incontinence frequency, and success rate. Success was defined as defecation frequency of >= 3 times per week and fecal incontinence frequency of <= 1 times per 2 weeks irrespective of laxative use. Secondary outcomes were stool-withholding behavior and behavior problems. Outcomes were evaluated at the end of treatment and at 6-months follow-up. All of the analyses were done by intention to treat. RESULTS: Defecation frequency was significantly higher for conventional treatment. Fecal incontinence frequency showed no difference between treatments. After 22 weeks, success rates did not differ between conventional treatment and behavioral therapy (respectively, 62.3% and 51.5%), nor did it differ at 6 months of follow-up (respectively, 57.3% and 42.3%). The proportion of children withholding stools was not different between interventions. At follow-up, the proportion of children with behavior problems was significantly smaller for behavioral therapy (11.7% versus 29.2%). CONCLUSION: Behavioral therapy with laxatives has no advantage over conventional treatment in treating childhood constipation. However, when behavior problems are present, behavioral therapy or referral to mental health services should be considered. Reproduced with permission from Pediatrics. Copyright by the American Academy of Pediatrics. Full text (sometimes free) may be available at these link(s):  help |
