title: A multicenter study on childhood constipation and fecal incontinence: effects on quality of life.
abstract: OBJECTIVE
  To describe the effects of childhood functional constipation compared with functional constipation plus fecal incontinence on quality of life, evaluating effects on physical, psychosocial, and family functioning.
  
  
  METHODS
  This prospective, multicenter study collected data from 5 regional children's hospitals. Children meeting Rome III criteria for functional constipation were included. Parents completed the following 5 instruments: Pediatric Quality of Life Inventory (PedsQL), PedsQL-Family Impact Module, Functional Disability Inventory-Parent Version, Pediatric Inventory for Parents (PIP), and Pediatric Symptom Checklist-Parent Report.
  
  
  RESULTS
  Families of 410 children aged 2-18 years (mean [SD], 7.8 [3.5] years; 52% male) were included. Children with functional constipation+fecal incontinence had worse quality of life than children with functional constipation alone (PedsQL Total Score, P ≤ .03). Older children with functional constipation + fecal incontinence had lower quality of life than their younger counterparts (PedsQL Total Score, P ≤ .047). Children with functional constipation+fecal incontinence had worse family functioning (PedsQL-Family Impact Module Total Score, P ≤ .012), greater parental stress (PIP-F Total Score, P ≤ .016; PIP-D Total Score, P ≤ .013), and poorer psychosocial functioning (Pediatric Symptom Checklist Total Score, P ≤ .003). There were no statistically significant between-group differences in physical functioning based on the functional Disability Inventory.
  
  
  CONCLUSIONS
  Fecal incontinence significantly decreases quality of life compared with functional constipation alone in children. Older children with functional constipation+fecal incontinence may be at particular risk. Strategies for early identification and treatment of constipation along with diagnosis and treatment of related adjustment difficulties may mitigate the negative impact of this highly prevalent condition.
authors.affiliation: Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Katja
authors.initials: K
authors.lastname: Kovacic
authors.affiliation: Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Manu R
authors.initials: MR
authors.lastname: Sood
authors.affiliation: Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mugie
authors.affiliation: Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
authors.affiliation: Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
authors.affiliation: Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Heinz
authors.affiliation: Division of Pediatric Gastroenterology, University of South Alabama Children's and Women's Hospital, Mobile, AL.
authors.forename: Ananthasekar
authors.initials: A
authors.lastname: Ponnambalam
authors.affiliation: Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Christina
authors.initials: C
authors.lastname: Beesley
authors.affiliation: Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Rina
authors.initials: R
authors.lastname: Sanghavi
authors.affiliation: Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000150:complications; D005242:Fecal Incontinence / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D018434:Sickness Impact Profile