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Group Treatment of Fecal Incontinence

A Description of an Interdisciplinary Intervention

Gonring, Kelsey*; Dolan, Bridget*; Kapke, Theresa L.*; Begotka, Andrea; Sood, Manu; Silverman, Alan H.

Journal of Pediatric Gastroenterology and Nutrition: April 15, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002372
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Introduction: Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20–60% of cases. A combined medical-behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group-based treatment for fecal incontinence in school-aged children, and to present a description of changes in treatment adherence rates that impact clinical effectiveness.

Method: Poop Group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6-week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre- to post-treatment. Group sessions focus on (1) the GI system, (2) medication, (3) toilet sitting posture, (4) hydration, (5) fiber, and (6) behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed.

Results: Nineteen families completed the 6-week protocol. Appropriate stool frequency was improved (p ≤ 0.01), and soiling was reduced (p ≤ .00). Medication adherence was also improved (p ≤ 0.04). Treatment results were maintained at one-month follow-up.

Discussion: Poop Group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment. The developmentally targeted interventions and the interdisciplinary focus of treatment likely account for treatment successes.

*Marquette University,

Children's Hospital of Wisconsin

Medical College of Wisconsin.

Address correspondence and reprint requests to Alan H. Silverman, PhD, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee WI 53226 (e-mail: asilverm@mcw.edu).

Received 29 August, 2018

Accepted 8 March, 2019

Author Note: Kelsey Gonring, PhD is now at the Department of Pediatrics Rush University Medical Center; Bridget Dolan & Theresa L. Kapke are in the Department of Clinical Psychology; Manu Sood & Alan H. Silverman are in the Department of Pediatrics

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,