Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children

Abstract

Background

Faecal incontinence is a common and potentially distressing disorder of childhood.

Objectives

To assess the effects of behavioural and/or cognitive interventions for the management of faecal incontinence in children.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 October 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. We contacted authors in the field to identify any additional or unpublished studies.

Selection criteria

Randomised and quasi‐randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of faecal incontinence in children.

Data collection and analysis

Reviewers selected studies from the literature, assessed study quality, and extracted data. Data were combined in a meta‐analysis when appropriate.

Main results

Twenty one randomised trials with a total of 1371 children met the inclusion criteria. Sample sizes were generally small. All studies but one investigated children with functional faecal incontinence. Interventions varied amongst trials and few outcomes were shared by trials addressing the same comparisons.

Combined results of nine trials showed higher rather than lower rates of persisting symptoms of faecal incontinence up to 12 months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78 to 1.58). This result was consistent with that of two trials with longer follow‐up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal manometry to conventional treatment did not result in higher success rates in chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months).

In one small trial the adjunct of behaviour modification to laxative therapy was associated with a significant reduction in children's soiling episodes at both the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR 0.20 CI 95% 0.06 to 0.65).

Authors' conclusions

There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of functional faecal incontinence in children. There was not enough evidence on which to assess the effects of biofeedback for the management of organic faecal incontinence. There is some evidence that behavioural interventions plus laxative therapy, rather than laxative therapy alone, improves continence in children with functional faecal incontinence associated with constipation.

Plain language summary

Behavioural interventions for the treatment of faecal incontinence in children

Children with "faecal incontinence" cannot control their bowel movements and so they soil their underwear. Sometimes people use the word "soiling" or "encopresis" to mean the same thing. Faecal incontinence can be caused by either physical or psychological problems. The term "organic faecal incontinence" is used when faecal incontinence is due to a physical damage or abnormality whilst "functional faecal incontinence" is used when faecal incontinence is caused by non‐organic/psychological factors. Behavioural interventions (toilet training, rewards) are used to reduce children's anxiety and to restore normal bowel habits. Biofeedback is a technique that can be used to teach children how to control the muscles around their back passage.

This review identified 21 studies with a total of 1371 children. Behavioural interventions when used together with laxative therapy may improve continence in children with non‐organic faecal incontinence and constipation whilst biofeedback does not add any long‐term benefit. Children who received biofeedback treatment had not always been evaluated beforehand for the suitability of the treatment.

There was not enough evidence to assess the effects of biofeedback in children with organic faecal incontinence.