NEW YORK (Reuters Health) - For treating constipation problems in children, behavioral therapy given along with laxatives isn't any more effective than laxatives alone, Dutch researchers report.
However, the therapy does improve behavior problems, which frequently accompany constipation in kids, Dr. Marieke van Dijk of Emma Children's Hospital in Amsterdam and colleagues found.
Childhood constipation is common, the researchers note in the May issue of Pediatrics, with prevalence rates as high as 29 percent in some parts of the world. As many as 84 percent of children with constipation also have fecal incontinence, while more than a third have behavioral problems, they add. In the "vast majority" of cases, according to the researchers, children with the condition don't have anything physically wrong with them.
Constipation can lead to a vicious cycle in which defecation becomes increasingly painful, causing children to become more and more afraid of going to the bathroom, the researchers say. For this reason, they sought to find out whether behavioral therapy designed to help children cope with this fear might aid in treating the condition.
The researchers randomly assigned 134 children, ranging in age from 4 to 18 years, to receive conventional therapy with laxatives for 22 weeks or laxatives along with 12 sessions of behavioral therapy. More than a third of children in both groups had serious behavioral problems.
After conventional therapy, children were defecating more frequently than those who also received behavioral therapy, while fecal incontinence rates were no different.
Success rates, defined as defecating three or more times weekly and having fecal incontinence once or less every two weeks, did not differ between the two groups from a statistical standpoint, with 62 percent of children given conventional therapy and 52 percent of children in the behavioral therapy group being treated successfully.
Six months after treatment, however, only 12 percent of children in the behavioral therapy group had serious behavior problems, compared to 29 percent of the conventional therapy group.
Based on the findings, van Dijk and her team conclude, it may be useful to screen children with constipation for behavioral problems, and offer behavioral therapy along with laxatives if the screening does identify behavioral issues.
SOURCE: Pediatrics, May 2008.
