title: Psychosocial co-morbidity affects treatment outcome in children with fecal incontinence.
abstract: Fecal incontinence is a common disorder in children. Many children with fecal incontinence have psychosocial co-morbidity. In this study, the effect of psychosocial co-morbidity on the treatment outcome of children with fecal incontinence was evaluated. One hundred and fifty children with fecal incontinence were treated in a multidisciplinary program. All children had been treated unsuccessfully for at least one year before entering the program. The treatment consisted of laxative treatment, psychosocial interventions, and biofeedback training. Psychosocial co-morbidity was classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). One hundred and forty-one children were completely analyzed (102 boys, mean age 9.6 (range 6.5-16.5) years). Of these, 31 (22%) children had fecal incontinence without constipation and 110 (78%) children had fecal incontinence associated with constipation. In 95% of children, at least one psychosocial co-morbidity was present. Treatment was successful at 12 months in 69% of patients. Treatment was less successful in children with attention deficit hyperactivity disorder (ADHD), in children with parent-child relational problems, and in mentally retarded children. The results indicate that the early assessment and treatment of psychosocial co-morbidity might improve treatment response in children with fecal incontinence. Children with fecal incontinence are treated less successfully in the first year if they have ADHD, parent-child relational problems, or mental retardation. Psychosocial evaluation and the early assessment and treatment of psychosocial co-morbidity is indicated in order to improve response rate. Family counseling--aimed at improving parent-child relations--should be an integral part of a multidisciplinary treatment program for fecal incontinence.
authors.affiliation: Youth Department Kores, GGZ Group Europoort, Rotterdam, The Netherlands.
authors.forename: Els Q
authors.initials: EQ
authors.lastname: van Everdingen-Faasen
authors.forename: Bert J
authors.initials: BJ
authors.lastname: Gerritsen
authors.forename: Paul G H
authors.initials: PG
authors.lastname: Mulder
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Fliers
authors.forename: Michael
authors.initials: M
authors.lastname: Groeneweg
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification / Q000150:complications*; D001521:Behavior Therapy; D001676:Biofeedback, Psychology; D002648:Child; D003248:Constipation / Q000150:complications* / Q000188:drug therapy; D005242:Fecal Incontinence / Q000145:classification / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D010287:Parent-Child Relations; D011613:Psychotherapy
chemical_list: D054368:Laxatives