Biopsychosocial treatment of defecation problems in children with anal atresia: a retrospective study

In a retrospective study, we examined whether multidisciplinary treatment b ased on a biopsychosocial approach and carried out by a pediatric surgeon, a child psychologist, and a pediatric physiotherapist is successful in redu cing defecation problems (incontinence and/or constipation) in children wit h operated anal atresia (AA) (mean age 6.9 +/- 4.01 years). A second questi on was whether this treatment is successful in young children aged 2-5 year s. The multidisciplinary approach consisted of standard medical treatment a nd a behavioral program to teach children and their parents adequate defeca tion behavior including an adequate straining technique. Forty-three childr en aged 2-16 years were included: 27 boys and 16 girls with AA, of whom 26 had high or intermediate and 17 low AA. Besides continence and constipation , defecation behavior and straining technique were evaluated. The children improved significantly during treatment in all aspects of defecation. No di fferences in effect of treatment were found between young children (2-5 yea rs) and older ones, so this treatment seems to be equally effective in both age groups. This study demonstrates that both somatic and behavioral facto rs contribute to the persistence of chronic defecation problems. It is conc luded that treatment of these problems in patients with operated AA should include behavioral modification techniques.