title: Functional urinary and fecal incontinence in neurologically normal children: symptoms of one 'functional elimination disorder'?
abstract: OBJECTIVE
  To clarify the relationship between disordered defecation and non-neuropathic bladder-sphincter dysfunction (NNBSD) by comparing the prevalence of symptoms of disordered defecation in children with NNBSD before and after treatment for urinary incontinence (UI), and assessing the effect of such symptoms on the cure rate for UI.
  
  
  METHODS
  In the European Bladder Dysfunction Study, a prospective multicentre study comparing treatment plans for children with NNBSD, 202 children completed questionnaires on voiding and on defecation, at entry and after treatment for UI. Four symptoms of disordered defecation were evaluated; low defecation frequency, painful defecation, fecal soiling, and encopresis.
  
  
  RESULTS
  At entry, 17 of the 179 children with complete data sets had low defecation frequency and/or painful defecation (9%), classified as functional constipation (FC). Of the 179 children, 57 had either isolated fecal soiling or soiling with encopresis (32%), classified as functional fecal incontinence (FFI). After treatment for UI, FFI decreased to 38/179 (21%) (statistically significant, P = 0.035); for FC there were too few children for analysis. After treatment for UI, 19 of the 179 children (11%) reported de novo FFI. Symptoms of disordered defecation did not influence the cure rate of treatment for UI.
  
  
  CONCLUSIONS
  FFI improved significantly after treatment for UI only, but not in relation to the outcome of such treatment. FFI did not influence the cure rate for UI. There was little to support a causal relation between disordered defecation and NNBDS ('functional elimination syndrome').
authors.affiliation: Department of Paediatric Nephrology, University Hospital Antwerp, Belgium. anbael@attglobal.net
authors.forename: An M
authors.initials: AM
authors.lastname: Bael
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.forename: Hildegard
authors.initials: H
authors.lastname: Lax
authors.forename: Hannsjörg
authors.initials: H
authors.lastname: Bachmann
authors.forename: Ellen
authors.initials: E
authors.lastname: Janhsen
authors.forename: Tom P V M
authors.initials: TP
authors.lastname: De Jong
authors.forename: Marianne
authors.initials: M
authors.lastname: Vijverberg
authors.forename: Jan D
authors.initials: JD
authors.lastname: Van Gool
mesh_terms: D002648:Child; D003248:Constipation / Q000209:etiology / Q000503:physiopathology; D019960:Elimination Disorders / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D001743:Urinary Bladder / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology