Incontinencia fecal funcional en niños

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Abstract

La incontinencia fecal se define como la evacuación de deposiciones fecales en un lugar inadecuado. Este molesto síntoma es el origen de malestar y turbación considerables tanto para el niño o niña como para su familia. La incontinencia fecal pediátrica puede dividirse en dos categorías principales: (1) Incontinencia fecal orgánica resultante, por ejemplo, de malformaciones anorrectales o anomalías neurógenas; (2) incontinencia fecal funcional. En esta revisión abordaremos únicamente la incontinencia fecal funcional en niños y comentaremos la definición, la epidemiología, la fisiopatología y las actualizaciones recientes sobre aspectos clínicos y diagnósticos de la incontinencia fecal funcional.

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Most cited references 41

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Childhood functional gastrointestinal disorders.

S Cucchiara, P Hyman, V J Hyams … (1999)

This is the first attempt at defining criteria for functional gastrointestinal disorders (FGIDs) in infancy, childhood, and adolescence. The decision-making process was as for adults and consisted of arriving at consensus, based on clinical experience. This paper is intended to be a quick reference. The classification system selected differs from the one used in the adult population in that it is organized according to main complaints instead of being organ-targeted. Because the child is still developing, some disorders such as toddler's diarrhea (or functional diarrhea) are linked to certain physiologic stages; others may result from behavioral responses to sphincter function acquisition such as fecal retention; others will only be recognizable after the child is cognitively mature enough to report the symptoms (e.g., dyspepsia). Infant regurgitation, rumination, and cyclic vomiting constitute the vomiting disorders. Abdominal pain disorders are classified as: functional dyspepsia, irritable bowel syndrome (IBS), functional abdominal pain, abdominal migraine, and aerophagia. Disorders of defecation include: infant dyschezia, functional constipation, functional fecal retention, and functional non-retentive fecal soiling. Some disorders, such as IBS and dyspepsia and functional abdominal pain, are exact replications of the adult criteria because there are enough data to confirm that they represent specific and similar disorders in pediatrics. Other disorders not included in the pediatric classification, such as functional biliary disorders, do occur in children; however, existing data are insufficient to warrant including them at the present time. For these disorders, it is suggested that, for the time being, clinicians refer to the criteria established for the adult population.

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Childhood constipation: longitudinal follow-up beyond puberty.

Rijk van Ginkel, Johannes Reitsma, Hans A. Büller … (2003)

Sparse data exist about the prognosis of childhood constipation and its possible persistence into adulthood. A total of 418 constipated patients older than 5 years at intake (279 boys; median age, 8.0 yr) participated in studies evaluating therapeutic modalities for constipation. All children subsequently were enrolled in this follow-up study with prospective data collection after an initial 6-week intensive treatment protocol, at 6 months, and thereafter annually, using a standardized questionnaire. Follow-up was obtained in more than 95% of the children. The median duration of the follow-up period was 5 years (range, 1-8 yr). The cumulative percentage of children who were treated successfully during follow-up was 60% at 1 year, increasing to 80% at 8 years. Successful treatment was more frequent in children without encopresis and in children with an age of onset of defecation difficulty older than 4 years. In the group of children treated successfully, 50% experienced at least one period of relapse. Relapses occurred more frequently in boys than in girls (relative risk 1.73; 95% confidence interval, 1.15-2.62). In the subset of children aged 16 years and older, constipation still was present in 30%. After intensive initial medical and behavioral treatment, 60% of all children referred to a tertiary medical center for chronic constipation were treated successfully at 1 year of follow-up. One third of the children followed-up beyond puberty continued to have severe complaints of constipation. This finding contradicts the general belief that childhood constipation gradually disappears before or during puberty.

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Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood.

V Loening-Baucke (1997)

To evaluate the frequency of urinary incontinence and urinary tract infection in children with chronic constipation and report on the resolution of these with treatment of the underlying constipation. We evaluated the frequency of urinary incontinence and urinary tract infection in 234 chronic constipated and encopretic children before, and at least 12 months after, the start of treatment for constipation. Twenty-nine percent complained of daytime urinary incontinence and 34% of nighttime urinary incontinence. Urinary tract infection was present in 11% and was more commonly present in girls than in boys (33% vs 3%). Vesicoureteral reflux was present in four and megacystis in four of the 25 children who had a voiding cystourethrogram because of urinary tract infection. One girl who came in had constipation and acute urinary retention. The treatment for constipation consisted of disimpaction and maintenance treatment, which included the prevention of reaccumulation of stools and reconditioning to normal bowel habits through timed toilet sitting. Follow-up, at least 12 months after start of treatment for constipation, revealed that the constipation was relieved successfully in 52%. Relief of constipation resulted in disappearance of daytime urinary incontinence in 89% and nighttime urinary incontinence in 63% of patients, and disappearance of recurrent urinary tract infections in all patients who had no anatomic abnormality of the urinary tract. Urinary symptoms were found in a significant number of children who had functional constipation and encopresis. With treatment of the constipation, most patients became clean and dry and further recurrence of urinary tract infections was prevented.

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Author and article information

Journal

Journal ID (publisher-id): ANS

Journal ID (doi): 10.1159/issn.0252-8185

Title: Annales Nestlé (Ed. española)

Publisher: S. Karger AG

ISBN: 978-3-8055-8398-5

ISBN: 978-3-8055-8399-2

ISSN (Print): 0252-8185

ISSN (Electronic): 1661-4003

Publication date Subscription-year: 2007

Publication date (Print): June 2008

Publication date (Electronic): 06 June 2008

Volume: 65

Issue: 2

Pages: 81-89

Affiliations

Departamento de Gastroenterología y Nutrición Pediátricas, Hospital Infantil Emma, Centro Médico Docente, Amsterdam, Países Bajos

Article

Publisher ID: 128572 Other ID: Ann Nestlé [Spa] 2007;65:81–89

DOI: 10.1159/000128572

SO-VID: 7f199de8-84f9-48d1-8228-3e58d9333283

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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Incontinencia fecal funcional en niños

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Karger: Nutrition and Dietetics

Most cited references 41

Childhood functional gastrointestinal disorders.

Childhood constipation: longitudinal follow-up beyond puberty.

Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood.

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