Abstract
Pediatric constipation/encopresis is thought to be due, in part, to paradoxical constriction of the external anal sphincter (EAS) muscle during attempted defecation. This inappropriate contraction can lead to delayed, impacted, painful, and infrequent bowel movements. Standard Medical Care (SMC) involves disimpaction with enemas, followed by laxative therapy and diet modification, to maintain frequent soft stools. Using the case control method, the efficacy of SMC alone was compared with SMC plus EAS electromyographic biofeedback aimed at eliminating paradoxical contraction. Thirteen consecutive chronically constipated children received SMC plus biofeedback, and were compared with 13 age- and sex-matched children who received only SMC. Biofeedback subjects demonstrated post-treatment elimination of EAS paradoxical constriction. At 16 months follow-up parents of biofeedback children reported significantly greater improvement in constipation, encopresis, laxative use, and painful bowel movements compared to SMC.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bellman, M. (1966). Studies on encopresis.Acta Paediatrica Scandinavioa, 56(Suppl 170), 1–151.
Bornstein, P., Balleweg, B., McLellarn, R., Wilson, W., Sturm, C., Andre, J., & Van Den Pol, R. (1983). The bathroom game: A systematic program for the elimination of encopretic behavior.Journal of Behavior Therapy and Experimental Psychiatry, 14, 67–71.
Keren, S., Wagner, Y., Heldenburg, D., & Golan, M. (1988). Studies of manometric abnormalities of the recto-anal region during defecation in constipated and soiling children: Modification through biofeedback therapy.American Journal of Gastroenterology, 83, 827–831.
Kegel, A. (1950). The physiologic treatment of poor tone and function of the genital muscles and of urinary stress incontinence.Western Journal of Surgery, Obstetrics and Gynecology, 63, 808–813.
Levine, M. D., & Bakow, H. (1976). Children with encopresis: A study of treatment outcome.Pediatrics, 58, 845–852.
Levine, M. (1975). Children with encopresis: A descriptive analysis.Pediatrics, 56, 412–416.
Loening-Baucke, V. (1990). Modulation of abnormal defecation dynamics by biofeedback treatment in chronically constipated children with encopresis.Journal of Pediatrics, 116, 214–222.
Lowery, S. P., Srour, J. W., Whitehead, W. E., & Schuster, M. M. (1985). Habit training as treatment of encopresis secondary to chronic constipation.Journal of Pediatric Gastroenterology and Nutrition, 4, 397–401.
Olness, K., McParland, F., & Piper, J. (1980). Biofeedback: A new modality in the management of children with fecal soiling.Journal of Pediatrics, 96, 505–509.
Pinho, M., Hosie, K., Bielecki, K., Keighley, M. R. B. (1991). Assessment of noninvasive intra-anal electromyography to evaluate sphincter function.Diseases of the Colon and Rectum, 34 (1), 60–71.
Sims, C. G., Remler, H., & Cox, D. J. (1987). Biofeedback and behavioral treatment of elimination disorders.Clinical Biofeedback and Health, 10(2), 28–55.
Singles, J. (1989). Evaluation of a biofeedback-based behavior modification treatment program for the treatment of chronic constipation.
Singles, J. M., Mikulka, P. J., Cox, D. J., & Mittal, R. (1992). An alternative biofeedback-based behavior modification treatment for a case of chronic constipation.Behavior Therapy and Experimental Psychiatry, 23(3), 231–235.
Walker, C., Kenning, M., & Saust-Kampanile, J. (1989).Treatment of childhood disorders. In E. Mash & R. Barkley (Eds.),Treatment of childhood disorders. New York: Guilford Press.
Weber, J., Ducrotte, P. H., Touchais, J. Y., Roussignol, C., & Denis, P. H. (1987). Biofeedback training for constipation in adults and children.Diseases of the Colon and Rectum, 30, 844–846.
Whitehead, W. E., Crowel, M. D., & Schuster, M. M. (1990). Functional disorders of the anus and rectum. In D. Drossman (Ed.)The functional gastrointestinal disorders. Seminars in gastrointestinal diseases (Vol. 1, pp. 74–84). Philadelphia: W. B. Saunders Co.
Whitehead, W. E., Parker, L., Bosmajian, L., Morrill-Corbin, E. D., Middaugh, S., Garwood, M., Cataldo, M. F., & Freeman, J. (1986). Treatment of fecal incontinence in children with Spina Bifida: Comparison of biofeedback and behavior modification.Archives of Physical Medicine and Rehabilitation, 67, 218–224.
Wright, L. (1975). Outcome of a standardized program for treating psychogenic encopresis.Professional Psychology, 6, 453–456.
Author information
Authors and Affiliations
Additional information
This research report was supported by the NIH under grant No. RO1 HD 28160.
Rights and permissions
About this article
Cite this article
Cox, D.J., Sutphen, J., Borowitz, S. et al. Simple electromyographic biofeedback treatment for chronic pediatric constipation/encopresis: Preliminary report. Biofeedback and Self-Regulation 19, 41–50 (1994). https://doi.org/10.1007/BF01720669
Issue Date:
DOI: https://doi.org/10.1007/BF01720669