Defecation problems in children with Hirschsprung's disease: a biopsychosocial approach

Although most patients with operated Hirschsprung's disease (HD) have good continence in adulthood, a majority have postoperative defection problems d uring school age. Persistence of chronic constipation and/or incontinence m ay have considerable consequences for psychosocial development, parent-chil d interactions, quality of life, and the child's general condition. Conside ring these consequences, it is important to treat these problems as early a s possible. From a biopsychosocial view, we developed a multidisciplinary t reatment aimed at reserving defecation problems by teaching the child bowel self-control, primarily by training optimal defecation skills and subseque ntly toilet behavior. This treatment, carried out by a child psychologist, a pediatric physiotherapist, and a pediatric surgeon, consists of five step s: explanation; extinction of fear and avoidance behavior; learning new def ecation behavior; learning an adequate straining technique; and generalizat ion toward daily life. The effect of the treatment was investigated retrosp ectively in 16 boys with operated HD. The children improved significantly i n all aspects during treatment, suggesting that multidisciplinary treatment can significantly reduce the postoperative chronic bowel problems of most children with operated HD. The treatment was as effective in young children (2-5 years) as in older children (5-14 years).