title: Systematic review and meta-analysis of behavioral interventions for fecal incontinence with constipation.
abstract: BACKGROUND
  Multiple treatments exist for fecal incontinence. However, the relative and additive influence of commonly used behavioral approaches remains unclear.
  
  
  OBJECTIVE
  We conducted a systematic review of randomized controlled trials to synthesize the effects of behavioral treatment of fecal incontinence with constipation in children aged 4-18 years. Mixed treatment comparisons (MTCs) and random effects models were used to analyze outcomes. Risk of bias and quality of evidence were rated.
  
  
  RESULTS
  Although 10 studies were identified for MTCs, results did not yield reliable or valid estimates. Four studies were retained for random effects pooled outcome analysis. Results indicated that behavioral intervention was more effective than control conditions for author-defined success and soiling frequency.
  
  
  CONCLUSIONS
  Although evidence supports behavioral treatments for fecal incontinence with constipation in children, available evidence is limited. More and higher-quality trials are needed to better understand the relative effects of different treatments, including behavioral strategies.
authors.affiliation: Division of Psychology, Institute on Development & Disability, Oregon Health & Science University and Department of Public Health and Preventative Medicine, Oregon Health & Science University freemaku@ohsu.edu.
authors.forename: Kurt A
authors.initials: KA
authors.lastname: Freeman
authors.affiliation: Division of Psychology, Institute on Development & Disability, Oregon Health & Science University and Department of Public Health and Preventative Medicine, Oregon Health & Science University.
authors.forename: Andrew
authors.initials: A
authors.lastname: Riley
authors.affiliation: Division of Psychology, Institute on Development & Disability, Oregon Health & Science University and Department of Public Health and Preventative Medicine, Oregon Health & Science University.
authors.forename: Danny C
authors.initials: DC
authors.lastname: Duke
authors.affiliation: Division of Psychology, Institute on Development & Disability, Oregon Health & Science University and Department of Public Health and Preventative Medicine, Oregon Health & Science University.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000523:psychology / Q000628:therapy*; D005242:Fecal Incontinence / Q000523:psychology / Q000628:therapy*; D006801:Humans; D016896:Treatment Outcome
keywords: encopresis; evidence-based practice; fecal incontinence; meta-analysis; systematic review