Lack of benefit of laxatives as adjunctive therapy for functional nonretentive fecal soiling in children.
OBJECTIVE
To determine whether the combination of laxative treatment and biofeedback therapy (BF) is more effective for management of functional nonretentive fecal soiling than biofeedback therapy alone.


METHODS
In a prospective nonblinded study, 48 children were randomized in 2 groups: treatment with oral laxatives (LAX) and 5 sessions of BF (BF + LAX) or 5 sessions of BF alone (BF) during a treatment intervention period of 7 weeks. Biofeedback was performed with perfused manometry catheters and rectal balloon distension. Training focused on awareness of balloon distension and instruction in correct defecation dynamics. Successful treatment was defined as <1 encopresis episode per 2 weeks.


RESULTS
At the end of the intervention period, the number of encopresis episodes was significantly decreased in both groups: from 7 (2 to 24) to 2 (0 to 17) in the BF group and from 7 (3 to 25) to 2 (0 to 14) in the BF + LAX group. However, children given BF alone had significantly higher success rates than children treated with BF and additional oral laxatives (44% to 11%).


CONCLUSIONS
There is no additional effect of laxative treatment in functional nonretentive fecal soiling. Children treated with BF in combination with laxatives showed a significantly lower success percentage compared with those treated with BF alone. These results suggest that children with functional nonretentive fecal soiling should be treated differently from children with constipation and encopresis.
van Ginkel
R
R
Division of Pediatric Gastroenterology and Nutrition, the Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Benninga
M A
MA
Blommaart
P J
PJ
van der Plas
R N
RN
Boeckxstaens
G E
GE
Büller
H A
HA
Taminiau
J A
JA
D000293:Adolescent; D001676:Biofeedback, Psychology / Q000379:methods; D002400:Cathartics / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000503:physiopathology*; D004688:Encopresis / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit; D006801:Humans; D008297:Male; D008365:Manometry; D011446:Prospective Studies; D016896:Treatment Outcome
D002400:Cathartics