EFFECTIVE BOWEL TRAINING IN ENCOPRETIC CHILDREN

Abstract

Eighteen encopretic children, 13 boys and 5 girls between the ages 5 and 13, enrolled in a biofeedback bowel training program. Fecal accidents ranged from one to three per day. Ten children were having no bowel movements in the toilet. An intra-anal perineometer was used to measure EMG contractions of the anal sphincter muscles. Biofeedback training utilized a visual display to teach relaxation and contraction of the anal sphincter. The patients were praised for appropriately turning the display lights on and off. Between training sessions, children practiced anal sphincter contractions and relaxations three times a day. Initial EMG contraction averaged 12 uv for all patients. Twelve of the 18 children could not completely relax the anal sphincter. Three children dropped out. Of the 15 children continuing in the program, there were 11 non-relaxers. After 6 months, 9 of 11 were able to completely relax the anal sphincter. Five were completely continent and 4 were having less than one accident per week. Three children who completely relaxed initially continued to relax; all became completely continent. Of the 3 not iinproved children, 2 were non-relaxers and did not learn to relax. There was no difference during training between groups for EMG contraction strength, averaging 13 uv in both the 12 improved and 3 not improved patients. Those encopretic children who learned to relax the anal canal had significant improvement in fecal continence. Effective bowel training in encopretic children was directly related to learning to relax the anal sphincter.

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