An interdisciplinary group treatment for fecal incontinence in children (called “Poop group” by investigators) is a promising alternative for up to 60% of patients who fail to respond to standard care, according to a study published in the Journal of Pediatric Gastroenterology and Nutrition. Poop group participation decreases soiling and improves frequency of appropriate stooling and medication compliance.
Pediatric incontinence is a common childhood problem, affecting approximately 5% of US children, and has a negative impact on the psychosocial functioning of children and caregivers. Between 20% and 60% of cases do not respond to standard medical management, and in these cases, a combined medical-behavioral model is usually recommended. This pilot study was designed to describe an interdisciplinary group treatment for fecal incontinence in school-age children as well as the changes in treatment adherence rates directly affecting clinical effectiveness.
Caregivers and children participating in Poop group attended separate, simultaneous therapy groups for 6 weeks (average 5.25 children per group, range 3-8). These 90-minute sessions were led by a pediatric psychologist, advanced nurse practitioner (APN), and advanced-level graduate student in a clinical psychology doctorate program who taught content at the appropriate developmental level for the caregiver vs child groups on 6 core components: medication management, physiology of fecal incontinence, hydration, fiber, toileting, and behavioral contracting. During the second half of each session, the APN gave each child a physical exam, followed by a family consultation. Families were given weekly homework and sticker charts to reinforce care regimens.
The most common form of medical management preceding the group treatment was the combined use of osmotic and stimulant medications. Out of 26 enrolled families, 20 completed the full Poop group protocol (attending ≥5 of 6 sessions), and 16 of these had nearly complete data available at both pretreatment and follow-up. The 4 families excluded had unclear or variable ratings for protocol goals. Of the 16 participants included, 9 (56%) already reported appropriate stooling pattern before treatment, and 8 of these 9 continued this pattern at follow-up. A statistically significant median increase was seen in stooling frequency at follow-up compared with pre-treatment stooling frequency (z=-2.058; P =.04). At pretreatment, 14 (88%) participants exhibited soiling, compared with 5 (31%) demonstrating no soiling at follow-up. Seven (44%) participants experienced some degree of soiling at follow-up, but 6 of these 7 experienced improvements, with fewer soiling events at follow-up compared with pre-treatment, for a statistically significant decrease in frequency (z=-2.857; P =.004). The 4 children (25%) identified as having poor medication adherence at pretreatment improved to adherent at follow-up, while the 8 (50%) who were compliant maintained this. Four (25%) had unknown information. Medication adherence was improved, but this was not statistically significant (z=-2.25; P =.125).
Study limitations included selection bias, convenience sampling, an inability to address all concerns, and a short timeline. However, study investigators concluded that the Poop group “may be beneficial to patients who fail traditional medical management.” Future studies can improve the current methodology by prospectively examining long-term effects and determining whether the gains are maintained over time.
Gonring K, Dolan B, Kapke TL, Begotka A, Sood M, Silverman AH. Group treatment of fecal incontinence: A description of an interdisciplinary intervention [published online September 1, 2019]. J Pediatr Gastroenterol Nutr. doi: 10.1097/MPG.0000000000002372