Review of the treatment literature for encopresis, functional constipation, and stool-toileting refusal

This review summarizes the literature an randomized, controlled, published studies involving medical, behavioral, psychological, and biofeedback treat ments for encopresis/functional constipation and stool-toileting refusal in preschool-age and school-age children. Nine such studies were located in t he literature involving school-age children. No randomized controlled treat ment studies involving preschool-age children have been published. This rev iew revealed no evidence to support the routine Else of psychotherapy or an al sphincter biofeedback in the treatment of pediatric fecal elimination dy sfunctions, beyond those benefits derived from a comprehensive medical-beha vioral intervention. Further this review indicated that paradoxical constri ction. of the External Anal Sphincter does not influence the treatment outc ome of either biofeedback or medical-behavioral interventions. There are re markably few controlled treatment outcome studies in this most important cl inical area. More research is needed that employs standard treatment outcom e variables.