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Meta-Analysis
. 2011 Dec 7;2011(12):CD002240.
doi: 10.1002/14651858.CD002240.pub4.

Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children

Miriam Brazzelli  1 , Peter V Griffiths, June D Cody, David Tappin
Affiliations
Meta-Analysis

Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children

Miriam Brazzelli et al. Cochrane Database Syst Rev. .

Abstract

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

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

Search methods: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 October 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. We contacted authors in the field to identify any additional or unpublished studies.

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

Data collection and analysis: Reviewers selected studies from the literature, assessed study quality, and extracted data. Data were combined in a meta-analysis when appropriate.

Main results: Twenty one randomised trials with a total of 1371 children met the inclusion criteria. Sample sizes were generally small. All studies but one investigated children with functional faecal incontinence. Interventions varied amongst trials and few outcomes were shared by trials addressing the same comparisons.Combined results of nine trials showed higher rather than lower rates of persisting symptoms of faecal incontinence up to 12 months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78 to 1.58). This result was consistent with that of two trials with longer follow-up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal manometry to conventional treatment did not result in higher success rates in chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months).In one small trial the adjunct of behaviour modification to laxative therapy was associated with a significant reduction in children's soiling episodes at both the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR 0.20 CI 95% 0.06 to 0.65).

Authors' conclusions: There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of functional faecal incontinence in children. There was not enough evidence on which to assess the effects of biofeedback for the management of organic faecal incontinence. There is some evidence that behavioural interventions plus laxative therapy, rather than laxative therapy alone, improves continence in children with functional faecal incontinence associated with constipation.

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Conflict of interest statement

None known.

Figures

1
1
PRISMA study flow diagram.
1.1
1.1. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 1 Children not cured or improved (fixed effects).
1.2
1.2. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 2 Children not cured or improved (random effects).
1.3
1.3. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 3 Children not cured or improved (sensitivity analysis).
1.4
1.4. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 4 Retentive children not cured or improved (sensitivity analysis).
1.6
1.6. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 6 Children with abnormal defaecation dynamics.
1.7
1.7. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 7 Resting anal pressure.
1.8
1.8. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 8 Maximum squeeze anal pressure.
1.9
1.9. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 9 Rectal sensation.
1.10
1.10. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 10 Rectosphincter reflex.
1.11
1.11. Analysis
Comparison 1 Conventional treatment + biofeedback versus conventional treatment, Outcome 11 Saline retention test (ml).
2.1
2.1. Analysis
Comparison 2 Conventional treatment + anorectal manometry versus conventional treatment alone, Outcome 1 Children not cured or improved.
2.2
2.2. Analysis
Comparison 2 Conventional treatment + anorectal manometry versus conventional treatment alone, Outcome 2 Children who did not show a significant decrease in encopresis episodes.
2.3
2.3. Analysis
Comparison 2 Conventional treatment + anorectal manometry versus conventional treatment alone, Outcome 3 Children who were still using laxatives at 12 months.
2.4
2.4. Analysis
Comparison 2 Conventional treatment + anorectal manometry versus conventional treatment alone, Outcome 4 Children who did not show a significant increase in defaecation frequency.
3.1
3.1. Analysis
Comparison 3 Biofeedback + laxative therapy versus biofeedback, Outcome 1 Children not cured or improved.
4.1
4.1. Analysis
Comparison 4 Behaviour modifications + laxatives versus behaviour modifications alone, Outcome 1 Children not cured or improved.
4.2
4.2. Analysis
Comparison 4 Behaviour modifications + laxatives versus behaviour modifications alone, Outcome 2 Children who had more than one relapse.
5.1
5.1. Analysis
Comparison 5 Web‐based behaviour intervention versus no web‐based intervention, Outcome 1 Children not cured.
8.1
8.1. Analysis
Comparison 8 Biofeedback in the laboratory and at home versus biofeedback in the laboratory only, Outcome 1 Bowel movements per week.
8.2
8.2. Analysis
Comparison 8 Biofeedback in the laboratory and at home versus biofeedback in the laboratory only, Outcome 2 Soiling episodes per week.
8.3
8.3. Analysis
Comparison 8 Biofeedback in the laboratory and at home versus biofeedback in the laboratory only, Outcome 3 Days of laxatives use per week.
10.1
10.1. Analysis
Comparison 10 Behaviour modifications + laxative therapy versus laxative therapy alone, Outcome 1 Children not cured.
10.2
10.2. Analysis
Comparison 10 Behaviour modifications + laxative therapy versus laxative therapy alone, Outcome 2 Children not improved.
10.6
10.6. Analysis
Comparison 10 Behaviour modifications + laxative therapy versus laxative therapy alone, Outcome 6 Children on laxatives at 12 months.
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