Children with Constipation Manifest More Toileting Anxiety than Well Kids

Newswise — Researchers at the Cleveland Clinic Foundation Department of Pediatric Gastroenterology & Nutrition report that children with functional constipation have significantly more anxiety specific to toileting behavior than well children, without displaying significant general anxiety. The study was presented today at the American College of Gastroenterology's 68th Annual Scientific Meeting.

Anxiety specific to toileting behavior is hypothesized to play an important role in the development and maintenance of constipation. Constipation represents the chief complaint in 3 percent of pediatric outpatient visits and 10 to 25 percent of pediatric gastroenterology visits.

For their study, Rita Steffen, M.D., FACG, Tariq Ahmad, M.D. and Gerard Banez, Ph.D. studied 98 children (51 boys and 47 girls) between the ages of 6 and 18. Researchers examined whether children with functional constipation have more defecation anxiety than well children, and also compared constipated children to children with asthma, as a comparison to children with a chronic medical condition. Children participating in this research completed self-report measures of defecation anxiety and general anxiety, while their parents rated their children's defecation anxiety.

By self-report and parent report, children with functional constipation were found to have significantly more anxiety specific to toileting behavior than well children, and by parent report to have more defecation anxiety than a normative group of children with asthma.

The researchers observed that children with constipation did not manifest clinically significant general anxiety, but noted that defecation anxiety and general anxiety were positively correlated.

"Constipated kids were not generally anxious overall, but among those with defecation anxiety we saw an increase in general anxiety," said Gerard Banez, Ph.D., a child psychologist at the Cleveland Clinic Foundation. "It's important to note that we cannot infer any causality, only that those constipated children with greater defecation anxiety also exhibited increased general anxiety."

What Can Parents Do to Help Children with ConstipationAccording to Dr. Banez, parents of children with chronic constipation should take their children to a pediatrician to rule out any medical causes. Parents should also talk to a pediatrician about defecation anxiety if a child seems to be withholding stool, is tearful at the urge to use the toilet, or manifests vigorous resistance to using the toilet.

Parents should address their children's refusal to toilet by promoting what Dr. Banez calls "positive toilet sitting." Have the child sit on the toilet 3 to 5 times a day for a brief time, starting with as short a period as 30 seconds and gradually increasing to 5 minutes. He notes that it is acceptable during this phase for children to wear underwear or diapers. The goal is to learn to sit on the toilet and relax. Many constipated children are fearful of pain, resulting from a history of painful bowel movements. That fear can be generalized to sitting on the toilet.

Dr. Banez stresses the importance of diet changes to promote a soft, well-formed stool, including dietary fiber and possibly stool softeners.

A consistent toileting routine, on a schedule of 2 to 3 times a day for approximately 5 to 10 minutes, especially after meals, is another important strategy to help constipation in children according to Dr. Banez.

Parents might consider offering incentives to constipated children for using the toilet, and reward them for going on their own.

The ACG was formed in 1932 to advance the scientific study and medical treatment of disorders of the gastrointestinal (GI) tract. The College promotes the highest standards in medical education and is guided by its commitment to meeting the needs of clinical gastroenterology practitioners. Consumers can get more information on GI diseases through the following ACG-sponsored programs:· 1-800-978-7666 (free brochures on common GI disorders, including ulcer, colon cancer, gallstones, and liver disease)· 1-866-IBS-RELIEF and http://www.ibsrelief.org (free educational materials)· 1-800-HRT-BURN (free brochure and video on heartburn and GERD)· http://www.acg.gi.org (ACG's Web site)