Patients and methods
seizures, constipation, defecation disorders, spina bifida, neurologic diseases, injuries, metabolic abnormalities
CARDIAC DISEASES, DIABETES MELLITUS, HIRSCHSPRUNG DISEASE, CEREBRAL PALSY, HYPOTHYROIDISM, NEUROLOGICAL DISORDERS
The study was performed according to the Declaration of Helsinki principles, and approval was obtained from the ethical committee of the National Institute of Laser Enhanced Sciences (N.I.L.E.S) review board (Approval code 17/164 2021). The study was done in the Institute Pediatric outpatient clinics at Cairo University, Egypt, during the period from 2020 to 2021. The current research is RCT, including 40 children with FCC of both genders with a ratio of 50% male and 50% female in both groups.A written informed consent was obtained from the parents of the children. They were evaluated clinically by physicians for other gastrological and neurological disorders; some variables including defecation frequency, painful defecation, hard stool, inadequate evacuation sensation, manual maneuvers, and anorectal blockage were documented. Patients with evidence of organic causes for defecation disorders, such as Hirschsprung disease, spina bifida, hypothyroidism, metabolic abnormalities, or severe liver, anal, or cardiac diseases, were excluded. The same for patients receiving any medications that can cause constipation, or having diabetes mellitus, neurologic diseases (such as seizures and cerebral palsy), also patients with previous injuries in the pelvis or spine were excluded. The patients were divided randomly into two equal groups based on the treatment line.The participants went through a stratification process according to gender, and then, the stratified participants went through a restricted randomization process using the urn method. The patient selects one of 40 closed envelopes written in side envelopes method of treatment whether laser acupuncture or lactulose therapy.Study group (group A):1–20 patients were treated with laser acupuncture.Control group (group B): 21–40 patients were treated with lactulose syrup. Behavioral therapy was applied for all groups in the form of proper techniques of toileting, preferable time for defecation, as well as proper nutrition and fluid intake, and less fiber diet restriction, with a gender ratio of 50% male and 50% female in both groups.Lactulose syrup (1 to 3 mL/kg/day) was given to group B orally in divided doses 3 times weekly for 4 weeks (we used the lower dose limit as recommended by the pediatrician).