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Functional Fecal Retention With Encopresis in Childhood

Loening-Baucke, Vera

Journal of Pediatric Gastroenterology & Nutrition: January 2004 - Volume 38 - Issue 1 - pp 79-84
Original Articles-Gastroenterology

Objectives: The most common cause of encopresis in children is functional fecal retention (FFR). An international working team suggested that FFR be defined by the following criteria: a history of >12 weeks of passage of <2 large-diameter bowel movements (BMs) per week, retentive posturing, and accompanying symptoms, such as fecal soiling. These criteria are usually referred to as the ROME II criteria. The aims of this study were to evaluate how well the ROME II criteria identify children with encopresis; to compare these patients to those identified as having FFR by historical symptoms or physical examination; to determine whether 1-year treatment outcome varied depending on which definition for FFR was used; and to suggest improvements to the ROME II criteria, if necessary.

Methods: Data were reviewed from the history and physical examination of 213 children with encopresis. One-year outcomes identified were failure, successful treatment, or full recovery.

Results: Only 88 (41%) of the patients with encopresis fit the ROME II criteria for FFR, whereas 181 (85%) had symptoms of FFR by history or physical examination. Thirty-two (15%) patients did not fit criteria for FFR, but only 6 (3%) appeared to have nonretentive fecal soiling. Rates of successful treatment (50%) and recovery (39%) were not significantly different in the two groups.

Conclusions: The ROME II criteria for FFR are too restrictive and do not identify many children with encopresis who have symptoms of FFR. The author suggests that the ROME II criteria for FFR could be improved by including the following additional items: a history of BMs that obstruct the toilet, a history of chronic abdominal pain relieved by enemas or laxatives, and the presence of an abdominal fecal mass or rectal fecal mass.

The most common cause of functional encopresis (idiopathic fecal soiling) in children is functional fecal retention (FFR) (1). Children with encopresis have widely different symptoms, which suggests that there may be different underlying pathologies. Several investigators have attempted to develop objective tests by which to categorize children with constipation/encopresis, including measurements of intestinal transit (2–4), anorectal manometric parameters such as threshold for rectal sensation and critical volume inducing a strong urge to defecate (5,6), and defecation tests (6–9). Others have classified encopresis by other criteria, such as severity of encopresis, primary versus secondary encopresis, or by degree of constipation (6,10–14). Using the degree of constipation for classification, an international working team has suggested that children with encopresis should be classed as FFR or nonretentive fecal soiling on the basis of characteristic clusters of symptoms, the Rome II criteria (15). FFR was defined as fecal retention not associated with anatomic abnormalities or intake of medication.

The aims of this study were to (1) evaluate how well the ROME II criteria for FFR identifies children with encopresis; (2) compare children with encopresis identified by ROME II criteria with those identified as having FFR by historical symptoms or physical examination; (3) determine whether treatment outcome in children with FFR varies depending on which definition for FFR is used; and (4) suggest improvements to the ROME II criteria, if necessary.

Department of Pediatrics, University of Iowa, Iowa City, Iowa, U.S.A.

Received May 8, 2003;

revised September 11, 2003; accepted September 15, 2003.

Address correspondence and reprint requests to Dr. Vera Loening-Baucke, University of Iowa Hospitals and Clinics, Department of Pediatrics, JCP 2555, 200 Hawkins Drive, Iowa City, IA 52242 (e-mail: vera-loening-baucke@uiowa.edu).

© 2004 Lippincott Williams & Wilkins, Inc.