Behavioural and cognitive interventions with or without other treatments for defaecation disorders in children

Abstract

Background: Faecal soiling is a common and potentially distressing disorder of childhood.

Objectives: To assess the effects of behavioural and/or cognitive interventions for the management of defaecation disorders in children.

Search strategy: The following databases were searched: the Cochrane Incontinence Group Trials Register (March 2001), the Cochrane Controlled Trials Register (Issue 4, 2000), The Enuresis Resource and Information Centre Register of studies of encopresis and soiling, AMED (1985 to April 2000), PsycINFO (1887 to June 2000), Index to Theses - Great Britain and Ireland (October 2000), Dissertation Abstracts (November 2000), EMBASE (January 1998 to October 1999), SIGLE (January 1980 to December 1996), BIOSIS (January 1998 to March 1999), Science Citation Index (January 1998 to March 1999), ISTP (January 1982 to March 1999). Date of the most recent searches: March 2001. Bibliographies of trials retrieved were also searched and colleagues and experts in the field were contacted for information.

Selection criteria: Randomised and quasi-randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of defaecation disorders in children.

Data collection and analysis: Two reviewers independently selected studies from the literature. One reviewer assessed the methodological quality of eligible trials and extracted data. Data were combined in a meta-analysis when appropriate.

Main results: Sixteen randomised trials with a total of 843 children met the inclusion criteria. Sample sizes were generally small. Interventions varied among trials and few outcomes were shared by trials addressing the same comparisons. The synthesis of data from eight trials showed higher rather than lower rates of persisting problem up to 12 months when biofeedback was added to conventional treatment (OR 1.34 CI 95% 0.92 to 1.94). In two trials significantly more encopretic children receiving behavioural intervention plus laxative therapy improved compared with those receiving behavioural intervention alone at both the 6-month (OR 0.51 CI 95% 0.29 to 0.89) and the 12-month follow-up (OR 0.52 CI 95% 0.30 to 0.93). Similarly in another trial the addition of behaviour modifications to laxative therapy was associated with a marked reduction in children's soiling episodes (OR 0.14 CI 95% 0.04 to 0.51).

Reviewer's conclusions: There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of encopresis and constipation in children. There is some evidence that behavioural intervention plus laxative therapy, rather than behavioural intervention or laxative therapy alone, improves continence in children with primary and secondary encopresis.