Factors associated with outcome in management of defecation disorders. During toilet training, constipation occurs before stool toileting refusal. A community-based study of the prevalence of constipation in young children and the role of dietary fibre. Diet and chronic constipation in children: the role of fiber. Bowel frequency and defecatory patterns in children: a prospective nationwide survey. The micturition habits and prevalence of daytime urinary incontinence in Japanese primary school children. Biofeedback training in treatment of childhood constipation: a randomised controlled study Toilet training and toileting refusal for stool only: a prospective study. [Prevalence and risk factors of the development of irritable bowel syndrome in adolescents: a population study]. Functional gastrointestinal disorders in children: an Italian prospective survey. Bowel Frequency in Healthy Children The bowel habit of young children. Constipation and obesity: a statistical analysis. Childhood constipation: longitudinal follow-up beyond puberty. Defaecation pattern and intestinal transit in Nigerian children. Enuresis: prevalence and associated factors among primary school children in Saudi Arabia
Simple , incentive based behaviour modification , with or without a modest programme of psychotherapy involving outpatient visits every four to six weeks , seems to be associated with a useful cure rate in children with lower bowel function disorders . Appreciable social disadvantage seems to be the most important factor mitigating against a successful outcome , associated with non-compliance with treatment . Failure to respond to treatment was associated with important psychological problems . These were more common in the socially disadvantaged groups . Children from satisfactory social background s who have lower bowl disturbances can be effectively treated by fairly simple programmes . More elaborate and expensive strategies should be reserved for those whose psychosocial circumstances make it possible to predict a less satisfactory outcome BACKGROUND Previous studies demonstrated that constipation and painful defecation are associated with stool toileting refusal ( STR ) , but whether they are the result of STR or occur before this behavior is not known . OBJECTIVE To determine whether constipation and painful defecation occur as a result of STR or occur before STR . METHODS Three hundred eighty children between 17 and 19 months of age participated in a prospect i ve longitudinal study of toilet training .  Children were monitored with telephone interviews every 2 to 3 months until the completion of daytime toilet training . Information obtained in follow-up interviews included parents ' reports on the presence and frequency of hard bowel movements , painful defecation , and child toilet training behaviors .  Children were defined as completing daytime toilet training when they were experiencing < 4 urine accidents per week and < or = 2 episodes of fecal soiling per month . Children were defined as having frequent hard bowel movements if the parents reported a hard bowel movement approximately once per week in > or = 2 follow-up telephone interviews or more than once per week in 1 follow-up telephone interview . RESULTS The mean age at the completion of daytime toilet training was 36.8 + /- 6.1 months ( range : 22 - 54 months ) . Ninety-three children ( 24.4 % ) developed STR . Parents of children who developed STR , in comparison with the rest of the sample , were more likely to report that the child had experienced hard bowel movements ( 67.7 % vs 50.9 % ) , frequent hard bowel movements ( 29.0 % vs 14.3 % ) , and painful defecation ( 41.9 % vs 27.9 % ) . Of the children who experienced both STR and hard bowel movements , 93.4 % demonstrated constipation before the onset of STR . In that group , parents reported hard bowel movements at almost one-half of all follow-up telephone interviews before the onset of STR . Of the children who experienced both STR and painful defecation , 74.4 % experienced the first episode of painful defecation before the onset of STR . Children with frequent hard bowel movements demonstrated a longer duration of STR ( 9.0 + /- 6.5 vs 4.8 + /- 3.0 months ) . CONCLUSIONS When hard bowel movements or painful defecation is associated with STR , the first episode of constipation usually occurs before the STR . The fact that hard bowel movements frequently occur before the onset of STR suggests that for many of these children constipation is a chronic problem that is not being treated effectively . Therefore , hard bowel movements and painful defecation are factors that potentially contribute to the STR and for the majority of children are not caused solely by the STR behavior . Additional studies are needed to determine whether earlier and more effective treatment of constipation could decrease the incidence of STR OBJECTIVES To study the prevalence of constipation in young children , and to explore its association with dietary fibre intake . DESIGN Cross-sectional community-based study . SETTING Three kindergartens r and omly selected from the eastern district of Hong Kong . PARTICIPANTS Between October 2003 and January 2004 , parents of children aged 3 to 5 years completed a specially design ed question naire and a 3-day dietary record form , which were used to collect information on bowel function and dietary intake . Children with constipation were identified based on Rome criteria . Children with normal bowel habits served as a comparison group . MAIN OUTCOME MEASURES Dietary intake of energy , protein , and dietary fibre . RESULTS Of 778 children recruited , 561 complete sets of data were successfully obtained from the participating kindergartens . One hundred and sixty-six ( 29.6 % ) children were found to be constipated . The incidence of a family history of constipation was significantly higher in the constipated group ( 14 % ) than in the non-constipated group ( 7 % ) [ P=0.013 ] . Mean dietary fibre consumption was 4.1 g/d ( st and ard deviation , 2.3 g/d ) in all children corresponding to 45.5 % ( st and ard deviation , 24.9 % ) of the daily recommendation . Constipated children ( mean , 40.7 % ; st and ard deviation , 20.5 % ) had a significantly lower  dietary fibre intake of the daily recommendation than the non-constipated group ( mean , 47.5 % ; st and ard deviation , 26.2 % ) [ P=0.017 ] . CONCLUSION Up to 30 % of preschool children in the eastern district had constipation . A family history of constipation was related to its occurrence in the studied children . Dietary fibre intake was insufficient in all children and even lower in those who were constipated BACKGROUND Chronic constipation is one of the most common disorders in Western countries and despite numerous clinical , pathophysiologic , and epidemiologic studies its cause is still unclear . Several hypotheses have been proposed and according to experimental studies and clinical observation , fiber intake could play a role in its pathogenesis . The purpose of this case-control study was to examine the possible correlation of  idiopathic chronic constipation in children and dietary intake , particularly fiber intake . METHODS A r and omized sample of children ( 291 children with constipation and 1602 controls ) aged 2 to 14 years was taken from three of the 52 counties of Greece . Stratification was performed on the basis of urban , rural , or suburban location and socioeconomic status . The nutritional data were obtained from a 3-day dietary record and a dietary history . Statistical analysis was performed with multivariate tests , multivariate analysis of variance , discriminant analysis , and chi-square analysis according to the characteristics of the correlated variables . RESULTS Constipated children had a lower caloric and nutrient intake ( p < 0.001 ) , lower body weight/height ( p < 0.001 ) , and higher prevalence of reported anorexia ( p < 0.001 ) . Discriminant analysis indicated that  dietary fiber alone was independently negatively correlated with chronic constipation , despite the age and the age of onset of constipation . Relative risk also had a negative correlation with  fiber intake ( p < 0.001 ) . Of the main fiber fractions only cellulose and pentose were independently correlated with chronic constipation . CONCLUSIONS Lack of fiber may play an important role in the etiology of chronic idiopathic constipation in children BACKGROUND & AIMS Very little is known about several aspects of bowel habits in the general pediatric population and the aim of this nationwide survey was to assess bowel frequency and modalities of defecation in children . METHODS The survey was conducted by 58 pediatricians who were selected r and omly and distributed evenly throughout Italy . The following items were reported by each pediatrician in a st and ardized question naire : sociodemographic data , frequency and  modalities of bowel evacuation  , and anorectal disorders . RESULTS The response rate of available completed question naires was distributed evenly for the 1-year age group and was 94 % ( number of patients , 2680 ; 1 - 2 years , 442 ; females , 49.8 % ) . Mean bowel frequency did not vary in the first 2 years of life , it decreased ( P = .00001 ) after the second year , and remained stable until the 12th year ; it did not differ between sexes . Mean bowel frequency was reduced significantly in children , both in those younger or older than 2 years , with a positive history of constipation in the parents ( P = .00002 ) . Bowel frequency was inversely correlated with the number of persons living and the number of rooms in the child 's house ( P < .05 , P = .008 , respectively ) . Stool consistency , duration of evacuation , and frequency of episodes of painful defecation showed an inverse relationship ( P < .001 ) with bowel frequency . Bowel frequency was significantly lower ( P < .001 ) in children with anorectal disorders . CONCLUSIONS In Italian children , bowel frequency does not differ between sexes but it differed between the first 2 years of life and age older than 2 . Anorectal disorders increase as bowel frequency decreases PURPOSE We assessed the prevalence of daytime urinary incontinence ( DUI ) and the daytime frequency of voiding by age and sex in neurologically normal children in primary school . We also investigated the association of DUI with background factors . MATERIAL S AND METHODS We performed an anonymous question naire survey of DUI in primary school children . A total of 11 primary schools in Hiroshima City were r and omly selected and 6,917 school children 7 to 12 years old were enrolled . DUI was defined as any involuntary leakage of urine during the daytime occurring more frequently than once monthly in the 6 months before the survey . Slight dampness of the child underwear was also regarded as DUI . RESULTS The overall response rate was 76.4 % of 6,917 school children . The prevalence of DUI was 6.3 % and it was inversely related to age , decreasing from about 9 % at age 7 to 2 % at age 12 years . Children urinated about 5 or 6 times daily and increased daytime frequency occurred in 14.6 % of all children . Daytime frequency of voids , history of cystitis and infrequent bowel habits had a statistically significant positive correlation with DUI . CONCLUSIONS We found that the overall prevalence of DUI in primary school children was 6.3 % , gradually decreasing with age . Increased daytime frequency , history of cystitis and infrequent bowel habits were significantly related to DUI . The link between DUI and daytime frequency , urinary tract infections and constipation deserves more attention BACKGROUND Because abnormal defaecation dynamics , which can be modified by biofeedback , are considered to be the underlying problem in constipation , biofeedback training may be a useful treatment for constipation . This treatment has mainly been studied in uncontrolled trials . We evaluated defaecation dynamics and clinical outcome in chronically constipated children in a r and omised study comparing conventional treatment and conventional treatment with biofeedback training . METHODS Patients , 5 to 16 years old , were referred to the Academic Medical Center in Amsterdam by general practitioners , school doctors , paediatricians , and psychiatrists . They had to fulfil at least two of four criteria for paediatric constipation and were included if they had been treated medically for at least one month before r and omisation . Patients had a medical history , abdominal and rectal examination , and anorectal manometry at the start and end of the 6-week intervention period . The conventional group received laxative treatment with additional dietary advice , toilet training , and maintenance of a diary of bowel habits . The biofeedback group received the same conventional treatment and additionally five biofeedback training sessions . During the first 3 weeks , patients visited the outpatient clinic weekly ; two subsequent visits were twice monthly . FINDINGS 94 patients were r and omised to conventional treatment ( CT ) and 98 to conventional treatment with additional biofeedback training ( CT+BF ) .  Normal defaecation dynamics increased in the CT group from 41 % to 52 % ( not significant ) and in the CT+BF group from 38 % to 86 % ( p = 0.001 ) . At 6 weeks , more patients in the CT+BF group showed normal defaecation dynamics , compared to the CT group ( p < 0.001 ) . This result was unaltered by controlling for baseline status in a logistic regression model . At 1 year , successful treatment ( defaecation frequency > or = 3/week , soiling and /or encopresis < 2/month , and no laxatives ) was accomplished in 59 % of the CT and 50 % of the CT+BF group ( p = 0.24 ) . The results were maintained after 1 1/2 years follow-up . No association was found between achievement of normal defaecation dynamics and clinical outcome . INTERPRETATION Additional biofeedback training compared to conventional therapy did not result in higher success rates in chronically constipated children . Furthermore , achievement of normal defaecation dynamics was not associated with success : abnormal defaecation dynamics seem not to play a crucial role in the pathogenesis of childhood constipation .  Intensive conventional laxative treatment should remain the first choice in chronically constipated children OBJECTIVE To determine the incidence of toileting refusal for bowel movements and its outcome when toilet training children using a child-oriented approach . DESIGN Prospect i ve study . SETTING Private suburban pediatric setting consisting of middle and upper middle class families . METHODS Healthy children between 18 and 30 months with no signs of developmental delay were enrolled in the study . Parents were given questions regarding their child 's toilet training and behavior . Families were followed every 6 months during an office visit or by phone call until the child was successfully day time toilet trained . RESULTS A total of 482 children ( 255 males ) completed the study . There were 106 children ( 54 males ) ( 22 % ) who experienced at least 1 month of stool toileting refusal . There was an association between the presence of younger siblings ( P = .023 ) and parental inability to set limits for the child ( P = .017 ) and stool toileting refusal .  Stool toileting refusers trained at a later age than the rest of the group ( P < .0001 ) . Fifty percent ( 22/44 ) of the children who trained between 42 and 48 months and 73 % ( 8/11 ) of the children who trained after 48 months experienced stool toileting refusal . Sixty-one of the study children developed stool withholding during toilet training . Forty-nine ( 80 % ) of these children were stool toileting refusers ( P < .00001 ) . In 77 ( 73 % ) of the children no intervention was undertaken . Of these , the behavior lasted more than 6 months in 20 . Intervention was undertaken with 29 children , either because of severe stool withholding ( 23 ) or the age of the child ( 6 ) . Interupting toilet training and having the child return to diapers result ed in the child spontaneously using the toilet for bowel movements within 3 months in 24 of 27 children . CONCLUSION Stool toileting refusal occurred in one in five children in this study population . Two behaviors associated with stool toileting refusal may require the intervention of the pediatrician . The first is stool withholding causing constipation which can result in rectal impaction and primary encopresis . The second is lack of successful toilet training by 42 months of age . A child who is still untrained at this late age can be a source of family conflict and stress requiring the advice and support of the pediatrician AIM To determine prevalence of irritable bowel syndrome ( IBS ) and associated factors in a community-based population of adolescents . MATERIAL AND METHODS 189 schoolboys and 250 schoolgirls aged 14 - 17 years from four r and omly chosen schools of Novosibirsk participated in the study . RESULTS The prevalence of IBS defined according to Rome criteria was higher in girls ( 24 vs 14 % in boys , p = 0.01 ) . Colonic pain frequency was similar in both genders ( 11 % in girls vs 9 % in boys , p = 0.46 ) , however disturbed defecation occurred significantly more often in girls than in boys ( 16 vs 7 % , p = 0.003 ) . Half of the subjects who reported IBS had also dyspeptic symptoms .  Fiber-rich diet and /or laxatives to prevent constipation were used by 2 % of boys and 7 % of girls ( p = 0.012 ) . However , only one third of those having less than 3 stools a week thought it abnormal . IBS is associated with the age over 15 - 16 years , female gender , abdominal pain in childhood , appendectomy , irregular meals and smoking ( in girls ) . No association was found with other socio-demographic factors and serological markers of some infections and invasions ( H. pylori , G. lamblia , O. felineus , hepatitis viruses B and C ) . Of the persons with diagnosable IBS , 49 % have consulted a physician about it , 21 % have undergone upper endoscopy . School absenteeism was reported by 62 % of the IBS sufferers . CONCLUSION IBS is common among adolescents ( especially girls ) with the prevalence rates similar to those described in adults from West Europe and USA . These disorders are associated with significant disability and health care costs OBJECTIVES To assess the prevalence and natural history of  functional gastrointestinal disorders ( FGIDs ) in children using the Rome Criteria . METHODS Thirteen primary care pediatricians were r and omly selected from the Campania region of the Italian National Health Service . Each pediatrician completed a detailed FGID question naire on consecutive patients seen during a 3-month period . A total of 9660 patients aged birth to 12 years were enrolled prospect ively during this 3-month period . Follow-up was performed at 1- , 3- , and 12-month intervals . RESULTS A total of 194 children initially met strict criteria for at least 1 FGID . A total of 72 ( 37.1 % ) children had infant regurgitation , 26 ( 13.4 % ) had functional dyspepsia , 27 ( 13.9 % ) had irritable bowel syndrome , and 66 ( 34.1 % ) had functional constipation or other defecation disorders . All children who had a diagnosis of FGIDs were reevaluated at 1 , 3 , and 12 months to study the natural history of the illnesses . Additional evaluation revealed 5 children who had developed an organic diagnosis . Therefore , 5 ( 2.5 % ) of 194 children who had a diagnosis of FGIDs by the Rome criteria had a change in diagnosis to an organic disease during the study period , none of whom experienced permanent sequelae . CONCLUSIONS Of 194 children who received a prospect i ve diagnosis of FGIDs using the Rome criteria , 97.5 % continued to satisfy the diagnostic criteria or were improved at follow-up . The low prevalence of functional dyspepsia and irritable bowel syndrome in our population is most likely explained by the lack of adolescents in our sample ABSTRACT . Bowel frequency was recorded , on a diary sheet basis , in 662 children from six Italian cities . There is a wide interindividual variability , showing a sharp decrease with age ; we report the distribution of the percentiles in the different age groups . Among infants , the breast‐fed ones pass significantly more stools than the formula‐fed The bowel habit of 350 preschool children from a single general practice was studied . Eighty five per cent of 1 to 4 year olds eating a predominantly low fibre diet  opened their bowels once or twice a day and 96 % of the children fell within the range of three times a day to every other day . At all ages most children produced soft stools of about 25 ml volume . Mean intestinal transit time of 35 ( 10 % ) r and omly selected children was 33 hours . There is a significant correlation between infrequency of bowel action , longer transit time , hard stools , and the passage of blood Constipation frequency was investigated among 1897 subjects ( 874 males and 1023 females ) , ranging in age from 6 to 70 years , chosen at r and om between city inhabitants and farmers .  Bowel habit  was studied in 966 obese patients ( 390 males and 576 females ) . The authors followed for the diagnosis of constipation either the commonest and restrictive criterion of the weekly bowel actions or the clinical one which implies also others parameters , like hard or small stools , difficulties of expulsion or feeling of incomplete evacuation after defecation . The statistical analysis showed that constipation frequency is 8.3 % in obese patients and 1.5 % in normal-weighting , according to weekly bowel actions criterion : the difference is statistically significative ( p less than 0.001 ) BACKGROUND & AIMS Sparse data exist about the prognosis of  childhood constipation  and its possible persistence into adulthood . METHODS 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 prospect i ve data collection after an initial 6-week intensive treatment protocol , at 6 months , and thereafter annually , using a st and ardized question naire . RESULTS 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 % . CONCLUSIONS 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 The defaecation pattern and intestinal transit time of 410 apparently healthy children aged between 6 months and 5 years were studied by question naire and carmine red marker . The majority of the children ate a predominantly high residue diet .  Stool frequency varied from once every other day to 5 times a day , with 95 % of the children opening their bowels one to three times a day . There was a gradual decline in mean stool frequency with increasing age . The stool produced was usually soft and between 50 and 75 ml in size . Mean mouth to anus transit time in 98 r and omly selected children from the study group was 18.3 hours . The information obtained from this study should facilitate early identification of diarrhoea and constipation in the Nigerian pre-school child The aim of this study was to determine the prevalence of enuresis and the factors associated with it among primary school children . This is a cross‐sectional population ‐based study . Data were collected using a self‐administered question naire . Six hundred and forty school children aged 6–16 years were selected r and omly . Enuresis prevalence was 16.3 % among boys and 13.8 % among girls . The overall prevalence was 15 % . Breastfeeding , first born children , family integrity and stability were found to be protective . Stressful life events before the age of 6 years , deep sleep , acute family psycho‐social problems , recurrent urinary tract infection , constipation and congenital defects were found to be strongly associated with enuresis . Enuresis was also found to be associated with family history of enuresis . An important finding is that of the 83 children who had enuresis during sleep , 25 ( 30.1 % ) wet their beds during day time sleep ( day sleep wetting ) . The importance of enuresis as a health problem has been affirmed and specific guidelines were suggested
OBJECTIVE : A systematic review of the published literature was performed to assess the prevalence , incidence , natural history , and comorbid conditions of functional constipation in children .
CONCLUSION :  Childhood constipation  is a common problem worldwide .