title: Stressful Life Events in Children With Functional Defecation Disorders.
abstract: OBJECTIVE
  The aim of the study was to determine the prevalence of stressful life events including (sexual) abuse in children with functional defecation disorders by performing a systematic review.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and PsycINFO for cohort, case-control and cross-sectional studies investigating the prevalence of stressful life events, including (sexual) abuse in children with functional defecation disorders.
  
  
  RESULTS
  The search yielded 946 articles, of which 8 were included with data from 654 children with functional constipation and 1931 children with (constipation-associated) fecal incontinence (FI). Overall, children with functional defecation disorders had been significantly more exposed to stressful life events than healthy children, with prevalence rates ranging from 1.6% to 90.9%. Being bullied, being a relational victim, interruption of toilet training, punishment by parents during toilet training, and hospitalization were significantly related to FI, whereas separation from the best friend, failure in an examination, severe illness in a close family member, loss of job by a parent, frequent punishment, and living in a war-affected area were significantly related to constipation. Only 1 study measured the prevalence of child abuse, which reported a significantly higher prevalence of child (sexual) abuse in children with FI compared with controls.
  
  
  CONCLUSIONS
  The prevalence of stressful life events, including (sexual) abuse is significantly higher in children with functional defecation disorders compared with healthy children. To gain more insight into the true prevalence of child (sexual) abuse in children with functional defecation disorders, more studies are clearly needed.
authors.affiliation: *Department of Pediatric Gastroenterology and Nutrition †Department of Social Pediatrics, Emma Children's Hospital, Academic Medical Center ‡Medical Library, Academic Medical Center Amsterdam §Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Philips
authors.forename: Babette
authors.initials: B
authors.lastname: Peeters
authors.forename: Arianne H
authors.initials: AH
authors.lastname: Teeuw
authors.forename: Arnold G E
authors.initials: AG
authors.lastname: Leenders
authors.forename: Nicole
authors.initials: N
authors.lastname: Boluyt
authors.forename: Sonja N
authors.initials: SN
authors.lastname: Brilleslijper-Kater
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology; D003248:Constipation / Q000209:etiology* / Q000523:psychology; D003672:Defecation; D005242:Fecal Incontinence / Q000209:etiology* / Q000523:psychology; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology* / Q000523:psychology; D007422:Intestines / Q000503:physiopathology; D008016:Life Change Events; D015995:Prevalence; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology