title: Colonic washout enemas for persistent constipation in children with recurrent urinary tract infections based on dysfunctional voiding.
abstract: OBJECTIVE
  To describe the use of colonic washout enemas for persistent constipation in children treated for dysfunctional voiding by cognitive and biofeedback training.
  
  
  METHODS
  We treated 50 children, who had dysfunctional voiding and persistent dilatation of the rectum notwithstanding adequate oral laxatives, with colonic washout enemas. We performed retrograde filling of the rectum with 20 mL/kg water, starting once daily for 2 weeks, then 3 times per week for 6 to 12 months.
  
  
  RESULTS
  During the 6-month follow-up, 30 children were free from urinary tract infections. In 20 children we observed partial relief of complaints. On ultrasound all children showed a normalized diameter of the rectum. In 33 patients washout treatment could be stopped with continuing success. Relapse of a distended rectum triggered the need for chronic intermittent enema therapy in 17 patients. A few patients reported pain during enema treatment; otherwise, we noted no counter-effect.
  
  
  CONCLUSIONS
  Dysfunctional voiding combined with constipation in children can be cured by washout enemas if oral laxatives fail.
authors.affiliation: Paediatric Renal Centre, University Children's Hospital, UMC Utrecht, The Netherlands. rchrzan@umcutrecht.nl
authors.forename: Rafal
authors.initials: R
authors.lastname: Chrzan
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Klijn
authors.forename: Marianne A W
authors.initials: MA
authors.lastname: Vijverberg
authors.forename: Florentine
authors.initials: F
authors.lastname: Sikkel
authors.forename: Tom P V M
authors.initials: TP
authors.lastname: de Jong
mesh_terms: D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D003248:Constipation / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D012007:Rectum / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications* / Q000473:pathology; D014555:Urination Disorders / Q000150:complications* / Q000473:pathology