title: Biopsychosocial treatment of defecation problems in children with anal atresia: a retrospective study.
abstract: In a retrospective study, we examined whether multidisciplinary treatment based on a biopsychosocial approach and carried out by a pediatric surgeon, a child psychologist, and a pediatric physiotherapist is successful in reducing defecation problems (incontinence and/or constipation) in children with operated anal atresia (AA) (mean age 6.9 +/- 4.01 years). A second question was whether this treatment is successful in young children aged 2-5 years. The multidisciplinary approach consisted of standard medical treatment and a behavioral program to teach children and their parents adequate defecation behavior including an adequate straining technique. Forty-three children aged 2-16 years were included: 27 boys and 16 girls with AA, of whom 26 had high or intermediate and 17 low AA. Besides continence and constipation, defecation behavior and straining technique were evaluated. The children improved significantly during treatment in all aspects of defecation. No differences in effect of treatment were found between young children (2-5 years) and older ones, so this treatment seems to be equally effective in both age groups. This study demonstrates that both somatic and behavioral factors contribute to the persistence of chronic defecation problems. It is concluded that treatment of these problems in patients with operated AA should include behavioral modification techniques.
authors.affiliation: Department of Medical Psychology, University Hospital Nijmegen, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: van Kuyk
authors.forename: A T
authors.initials: AT
authors.lastname: Brugman-Boezeman
authors.forename: M
authors.initials: M
authors.lastname: Wissink-Essink
authors.forename: R S
authors.initials: RS
authors.lastname: Severijnen
authors.forename: C
authors.initials: C
authors.lastname: Festen
authors.forename: G
authors.initials: G
authors.lastname: Bleijenberg
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001006:Anus, Imperforate / Q000145:classification / Q000601:surgery*; D001521:Behavior Therapy / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000145:classification / Q000209:etiology* / Q000628:therapy*; D005242:Fecal Incontinence / Q000145:classification / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration*; D026741:Physical Therapy Modalities; D002666:Psychology, Child; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014039:Toilet Training; D016896:Treatment Outcome