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Pediatric Surgery International
Published in: Pediatric Surgery International 3/2020

01-03-2020 | Constipation | Original Article

Scientific solution to a complex problem: physiology and multidisciplinary team improve understanding and outcome in chronic constipation and faecal incontinence

Authors: Eleni Athanasakos, Sally Dalton, Susan McDowell, Tara Shea, Kate Blakeley, David Rawat, Stewart Cleeve

Published in: Pediatric Surgery International | Issue 3/2020

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Abstract

Purpose

There is a lack of diagnostic credibility to direct focused management for children with chronic constipation (CC) and faecal incontinence (FI). The aim is to assess the impact of an innovative Children’s Anorectal Physiology Service (CAPS) focusing on improving outcomes in children with CC/FI.

Methods

Prospective data: demographics, bowel and quality of life (QoL)/risk of distress questionnaires. Diagnostics: awake high-resolution anorectal manometry (AHRAM), endoanal ultrasound and transit marker studies (TMS).

Results

Total patients: 112; 66 males (59%); median 9 years (17 months to 16 years). Patient groups included: 89 (79%) had functional CC/FI; 9 (8%), Hirschsprung’s disease; 12 (11%), anorectal malformations and 2 (2%), trauma. St Marks Incontinence score (SMIS) abnormal in 91 (81%) and Cleveland Constipation Score (CCS) in 101 (90%) patients. Anorectal manometry: 94 (84%) awake and 18 (17%) under anaesthesia. Play specialist input 37 (33%) patients. AHRAM abnormal 65 (58%): sphincter dysfunction 36 (32%) and altered rectal sensation: hyposensitive 22% (20/91); 21% (19/91) hypersensitive. TMS normal in 64 (57%), 17 (15%) slow transit and 27 (24%) rectal evacuatory disorder. Risk of distress in 38% and poor QoL in 55% patients which correlated with abnormal SMIS (p = 0.02). Patient/parent satisfaction improved significantly (p < 0.05).

Conclusions

Scientific investigations combined with multidisciplinary team improve patient satisfaction and reduces patient self-report illness severity. A complex problem requires a scientific solution.
Appendix
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Metadata
Title
Scientific solution to a complex problem: physiology and multidisciplinary team improve understanding and outcome in chronic constipation and faecal incontinence
Authors
Eleni Athanasakos
Sally Dalton
Susan McDowell
Tara Shea
Kate Blakeley
David Rawat
Stewart Cleeve
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 3/2020
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-019-04605-y

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