title: Multidisciplinary behavioral treatment of defecation problems: a controlled study in children with anorectal malformations.
abstract: OBJECTIVE
  The most frequent consequences of being born with an anorectal malformation (ARM) are problems with fecal continence and constipation, which can have various negative implications. In this prospective, controlled study the effect of multidisciplinary behavioral treatment dealing with these problems is evaluated.
  
  
  METHODS
  The effect of multidisciplinary behavioral treatment was studied in 24 children (15 boys, 9 girls; mean age 5.8 years). Thirteen children were allocated to the treatment condition. The 11 children allocated to the waiting list control group also were treated after a waiting period of 6 months. Children underwent follow-up after treatment.
  
  
  RESULTS
  Compared with a waiting list control group, the experimental treatment group scores significantly better on 2 important measures ("Templeton," "Percentage of feces in toilet"). Although young children had poorer scores than older children before treatment, no significant differences in the favorable outcome of treatment were found between both groups after treatment. No effect of type of ARM on treatment was found either. The results of multidisciplinary behavioral treatment remain stable over a mean follow-up period of 7 months.
  
  
  CONCLUSIONS
  Multidisciplinary behavioral treatment is an important and valuable supplement to the standard medical treatment of children born with ARM suffering from chronic defecation problems.
authors.affiliation: Department of Medical Psychology, University Medical Centre Nijmegen, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: van Kuyk
authors.forename: M
authors.initials: M
authors.lastname: Wissink-Essink
authors.forename: A T
authors.initials: AT
authors.lastname: Brugman-Boezeman
authors.forename: H M
authors.initials: HM
authors.lastname: Oerlemans
authors.forename: M W
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
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: D001003:Anal Canal / Q000002:abnormalities*; D000704:Analysis of Variance; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis*; D003248:Constipation / Q000175:diagnosis / Q000628:therapy*; D003672:Defecation; D005242:Fecal Incontinence / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012016:Reference Values; D012720:Severity of Illness Index; D016896:Treatment Outcome