Prevalence of functional defecation disorders in European children: A systematic review and meta-analysis

Abstract

Objectives: Functional defecation disorders (FDDs) are common among children worldwide. The prevalence of these disorders has not been clearly described in Europe. This study performed a systematic review and meta-analysis on the prevalence of FDD in European children and assessed geographical, age, and sex distribution and associated factors.

Methods: PubMed, Embase, Psycinfo, Cochrane Library, and Cinahl were searched from 1999 to July 2023. Included studies were (1) prospective or cross-sectional studies of European population-based samples; (2) reporting the prevalence of infant dyschezia (ID) according to Rome II, III, or IV criteria or functional constipation (FC) or functional non-retentive fecal incontinence (FNRFI) according to Rome III or IV criteria; (3) aged 0-18 years; and (4) published in English, Dutch or Spanish. PRISMA guidelines for extracting data and assessing data quality were followed.

Results: Twenty-eight studies were included. Pooled prevalence was 6.9% (95% confidence interval [CI]: 3.1%-11.9%) for ID in infants 0-12 months (9 studies, n = 5611), 8.17% (95% CI: 6.33%-10.22%) for FC in children <4 years (25 studies, n = 35,189), 11.39% (95% CI: 9.34%-14.11%) for FC in children 4-18 years, and 0.24% (95% CI: 0.07%-0.49%) for FNRFI in children 4-18 years (7 studies, n = 16,873). No sex predominance was found for FC. FC prevalence did not differ significantly when diagnosed according to Rome III versus IV. FC prevalence differed between countries, with greatest rates in Italy, Germany, and Spain. No meta-analysis could be performed on other factors associated with FDD.

Conclusions: FDD is common in European children. Future longitudinal studies are needed to provide better insight into associated factors in pathogenesis.

Keywords: Europe; child; constipation; dyschezia; incontinence.

Figure 1

Forest plot of the prevalence of infant dyschezia reported across Europe with meta‐analysis. Where studies provide more than one prevalence rate on the same group of subjects at different points in time, the average prevalence is included in the meta‐analysis calculation. CI, confidence interval.

Figure 2

Forest plot of the prevalence of functional constipation reported. across Europe among children aged 0–4 years old with meta‐analysis. Where studies provide more than one prevalence rate on the same group of subjects at different points in time, the average prevalence is included in the meta‐analysis calculation. CI, confidence interval.

Figure 3

Forest plot of the prevalence of pediatric functional constipation reported. across Europe among children aged 4–18 years old, with meta‐analysis. denotes that the study is excluded from the meta‐analysis, since the study age group overlaps the 4‐year age threshold. CI, confidence interval.