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. 2019 Jan;178(1):33-39.
doi: 10.1007/s00431-018-3243-6. Epub 2018 Sep 27.

The problem of defecation disorders in children is underestimated and easily goes unrecognized: a cross-sectional study

Marjolijn E W Timmerman  1 , Monika Trzpis  2 , Paul M A Broens  3   2
Affiliations

The problem of defecation disorders in children is underestimated and easily goes unrecognized: a cross-sectional study

Marjolijn E W Timmerman et al. Eur J Pediatr. 2019 Jan.

Abstract

We aimed to study constipation and fecal incontinence in terms of prevalence, recognizing the disorders, help-seeking behavior, and associated symptoms. In this cross-sectional study, 240 children (8 to 18 years) from the general Dutch population completed a questionnaire about defecation disorders. After exclusions for anorectal/pelvic surgery or comorbidities, we analyzed 212 children. The prevalence of constipation was 15.6%; in a quarter of the cases, it co-occurred with fecal incontinence. We found 3% fecal incontinence without constipation. Even though children with a defecation disorder rated their bowel habits worse compared to children without defecation disorders (P < 0.001), 46% constipated children and 67% fecally incontinent children rated their bowel habits as good or very good. Moreover, 21 to 50% of children with a defecation disorder did not mention their symptoms to anybody. Interestingly, most constipated children had "normal" stool frequencies (64%) and consistencies (49%).Conclusion: The prevalence of constipation and fecal incontinence is quite high in children. Stool frequency and consistency is normal in half the constipated children, which may complicate the recognition of constipation. Finally, a considerable number of children does not recognize their disorders as constituting a problem and does not seek help, which leads to an underestimation of these disorders. What is Known: • Constipation and fecal incontinence are common in children, but their prevalence rates may be underestimated due to a variety of reasons. • Diagnosing these disorders remains challenging owing to the variety of symptoms and co-existence with other diseases. What is New: • The prevalence of constipation and fecal incontinence in children is high. • Many children do not recognize their defecation disorders as constituting a problem and do not seek help, which leads to an underestimation of the problem of these disorders.

Keywords: Constipation; Fecal incontinence; Help-seeking behavior; Prevalence; Stool consistency; Stool frequency.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Our local Medical Ethics Review Board (Medical Ethical Committee of the University Medical Center Groningen) waivered the need for formal extensive assessment by the committee.

Informed consent

Informed consent and/or parental consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1. Self-estimation of the quality of bowel habits.
Self-estimation of quality of bowel habits given by children with and without different defecation disorders. P < 0.001 for constipation and fecal incontinence compared to no defecation disorder
Fig. 2
Fig. 2. Help-seeking behavior.
Help-seeking behavior of children with constipation and fecal incontinence
Fig. 3
Fig. 3. Stool frequency and consistency.
a Stool frequency. P < 0.001 for constipation and fecal incontinence compared to no defecation disorder. b Stool consistency. P < 0.001 for constipation and fecal incontinence compared to no defecation disorder
See this image and copyright information in PMC

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