Original ResearchFull Report: Clinical—Alimentary TractEffectiveness of Pelvic Physiotherapy in Children With Functional Constipation Compared With Standard Medical Care
Section snippets
Trial Design and Participants
A pragmatic, single-blind, multicenter RCT was conducted in children aged between 5 and 16 years, who attended regular schools and had been referred to district hospitals.37 Children were diagnosed by the patient’s pediatrician with FC, according to the diagnostic Rome III criteria.7, 38 The study duration was 6 months from randomization.
Exclusion criteria were as follows: (1) prior physiotherapy because of bladder or bowel complaints, (2) urotherapy by another professional at inclusion, (3)
Participants
Figure 2 shows the trial flow and Table 2 lists the baseline characteristics of the allocated children. From December 2009 to May 2014, 111 children were considered eligible. In 31 cases, the parents refused to participate. Of the remaining 80 children, 27 (24.3%) were excluded before randomization, and 53 children were assigned randomly to the PPT (n = 26) or SMC (n = 27) group. At baseline, the children in both treatment groups were comparable in terms of clinical characteristics. Based on
Discussion
This multicenter RCT evaluating the effectiveness of PPT compared with SMC in children with FC showed that PPT performed better than SMC on all primary and secondary outcomes, with the exception of the SDQ. Furthermore, significantly more children receiving PPT were able to stop using laxative medication.
Our results are in accordance with those of Silva and Motta,36 who studied the effect of combined SMC and physiotherapy vs SMC alone in 72 children, age 4–18 years, affected by FC according to
Conclusion
This study found that children receiving PPT had significant improvements in symptom reduction, reduced PEG use, and improved quality of life compared with children receiving SMC only. These results suggest that PPT might be a valuable treatment option for FC in children, aged 5–16 years, and an early intervention may prevent chronicity. Further well-designed studies are necessary to assess whether all children or only specific subgroups with FC would benefit from PPT.
Acknowledgements
The authors would like to thank all of the children and their parents for participating in this trial. In addition, the authors would like to express their gratitude to all the health care providers who contributed, for their cooperation and support, in particular Elisabeth Blokhuis, Charlotte Dorrepaal, Ineke de Gee-de Ridder, Patricia van Gelderen, and Lilian Smeets.
References (55)
- et al.
Epidemiology of constipation in children and adults: a systematic review. Best practice and research
Clin Gastroenterol
(2011) - et al.
Functional defecation disorders in children with lower urinary tract symptoms
J Urol
(2013) - et al.
Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia
Gastroenterology
(2006) - et al.
Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation
Clin Gastroenterol Hepatol
(2007) - et al.
Pelvic floor spasms in children: an unknown condition responding well to pelvic floor therapy
Eur Urol
(2004) - et al.
Contraction of the pelvic floor muscles during abdominal maneuvers
Arch Phys Med Rehabil
(2001) - et al.
Pelvic floor muscle activity in different sitting postures in continent and incontinent women
Arch Phys Med Rehabil
(2008) - et al.
Sitting posture affects pelvic floor muscle activity in parous women: an observational study
Aust J Physiother
(2006) - et al.
Factorial validity of the Movement Assessment Battery for Children-2 (age band 2)
Res Dev Disabil
(2011) Rehabilitation of pelvic floor muscles utilizing trunk stabilization
Man Ther
(2004)
Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status
J Clin Epidemiol
Biofeedback training in treatment of childhood constipation: a randomised controlled study
Lancet
Pediatricians' attitudes toward randomized controlled trials involving children
J Pediatr
Constipation in children: fibre and probiotics
BMJ Clin Evid
Quality of life is impaired in children with functional defecation disorders
J Pediatr (Rio J)
Psychological differences between children with and without soiling problems
Pediatrics
Prevalence and associated clinical characteristics of behavior problems in constipated children
Pediatrics
Constipation in children: novel insight into epidemiology, pathophysiology and management
J Neurogastroenterol Motil
Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN
J Pediatr Gastroenterol Nutr
Epidemiology of childhood constipation: a systematic review
Am J Gastroenterol
Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children
Cochrane Database Syst Rev
Childhood constipation: is there new light in the tunnel?
J Pediatr Gastroenterol Nutr
Constipation in childhood
Nat Rev Gastroenterol Hepatol
Biofeedback therapy for dyssynergic defecation
World J Gastroenterol
[Evidence-based guideline development in the Netherlands: the EBRO platform]
Ned Tijdschr Geneeskd
Nonpharmacologic treatments for childhood constipation: systematic review
Pediatrics
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2023, Handbook of Gastrointestinal Motility and Disorders of Gut-Brain Interactions, Second EditionNonpharmacologic Treatment for Children with Functional Constipation: A Systematic Review and Meta-analysis
2022, Journal of PediatricsCitation Excerpt :Adverse events were not reported in any of the studies. Although multiple studies describe the use of pelvic muscles exercises in the treatment of children with functional constipation,78,79,86,88 only 1 study, including 53 children, specifically evaluated the effect of the addition of pelvic muscle exercises to laxative treatment, with a low risk of bias.88 Treatment success rates were significantly higher in the group whom received additional pelvic physiotherapy.
Non-pharmacologic approach to pediatric constipation
2021, Complementary Therapies in MedicineCitation Excerpt :A Dutch multicenter RCT also showed treatment success (absence of FC by Rome 3 criteria after 6 months) (92.3 vs 63 %, p = 0.011) with PFPT, cessation of laxative use (p = 0.009) and improvement in the child (p = 0.028) and parental (p = 0.047) quality of life. In this trial, PFM training included exercise therapy, myofeedback, rectal balloon training, as well as attention to breathing, relaxation, awareness of body posture, urge and coordination of PFM during filling and straining.83 A small study demonstrated that home PFPT for 8 weeks improved stool frequency (p < 0.01), stool diameter (p < 0.05) and consistency (p < 0.001) in 40 children with FC 4–18 years of age but did not change stool withholding behavior (p = 0.541), fecal impaction (p = 1), fecal incontinence (p = 0.136) or painful defecation (p = 1).84
Foot reflexology in the management of functional constipation: A systematic review and meta-analysis
2020, Complementary Therapies in Clinical PracticeCitation Excerpt :However, the cost of laxative use was noteworthy and the long-term efficacy and safety of laxatives were not conclusive [14]. Because of the adverse effects of medical treatment, some alternative therapies have been explored in recent years, with investigation showing that the application of complementary treatments has increased dramatically, such as acupuncture [15], pelvic physiotherapy [16], biofeedback therapy [17], abdominal massage [18], foot reflexology [19], probiotics and herbal medicine [20]. Foot reflexology is a non-invasive pressure and touch therapy.
Functional Constipation and Fecal Incontinence
2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
Conflicts of interest The authors disclose no conflicts.