Article

Faecal incontinence is a common and potentially distressing disorder
of childhood. OBJECTIVES: To assess the effects of behavioural and/or cognitive
interventions for the management of faecal incontinence in children. SEARCH
METHODS: We searched the Cochrane Incontinence Group Specialised Trials Register
(searched 28 October 2011), which contains trials identified from the Cochrane
Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and
handsearching of journals and conference proceedings, and the reference lists of
relevant articles. We contacted authors in the field to identify any additional
or unpublished studies. SELECTION CRITERIA: Randomised and quasi-randomised
trials of behavioural and/or cognitive interventions with or without other
treatments for the management of faecal incontinence in children. DATA COLLECTION
AND ANALYSIS: Reviewers selected studies from the literature, assessed study
quality, and extracted data. Data were combined in a meta-analysis when
appropriate. MAIN RESULTS: Twenty one randomised trials with a total of 1371
children met the inclusion criteria. Sample sizes were generally small. All
studies but one investigated children with functional faecal incontinence.
Interventions varied amongst trials and few outcomes were shared by trials
addressing the same comparisons.Combined results of nine trials showed higher
rather than lower rates of persisting symptoms of faecal incontinence up to 12
months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78
to 1.58). This result was consistent with that of two trials with longer
follow-up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal
manometry to conventional treatment did not result in higher success rates in
chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months).In
one small trial the adjunct of behaviour modification to laxative therapy was
associated with a significant reduction in children's soiling episodes at both
the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR
0.20 CI 95% 0.06 to 0.65). AUTHORS' CONCLUSIONS: There is no evidence that
biofeedback training adds any benefit to conventional treatment in the management
of functional faecal incontinence in children. There was not enough evidence on
which to assess the effects of biofeedback for the management of organic faecal
incontinence. There is some evidence that behavioural interventions plus laxative
therapy, rather than laxative therapy alone, improves continence in children with
functional faecal incontinence associated with constipation.

Langue : ANGLAIS