Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis

A model incorporating physiological, behavioral, and psychological paramete rs are presented to explain the maintenance and consequences of pediatric e ncopresis. It was hypothesized that the more comprehensive a treatment ill addressing these parameters, the more efficacious it could be and the more children it work, benefit. Eighty-seven children between the ages of 6 and 15 with the primary complaint of encopresis were randomly assigned to one o f three treatments: (a) Intensive Medical Care (IMC), receiving enemas for disimpaction and laxatives to promote frequent bowel movements; (b) Enhance d Toilet Training (ETT), rising reinforcement and scheduling to promote res ponse to defecation urges and instruction and modeling to promote appropria te straining, along with laxatives and enemas; or (c) Biofeedback (BF), dir ected at relaxing the external anal sphincter during attempted defecation, along with toiler training, laxatives, and enemas. Three months following i nitiation of treatment, ETT and BF produced similar reductions in soiling/c hild (76% and 65%) that,I cre superior (p's<.04) to IMC (21%). ETT signific antly benefited more children than the other two treatments, employing fewe r laxatives and fewer treatment sessions at a lower cost Consistent with th e presented model, reduction in soiling was associated with an increase in bowel movements in the toilet, reduction in parental prompting to use the t oilet, and defecation pain. These results demonstrate that ETT should be us ed routinely with laxative therapy in the treatment of chronic encopresis.