Amendola S, De Angelis P, Dall'oglio L, Di Abriola G Federici, Di Lorenzo M
Digestive Surgery, Endoscopic Unit, Department of Gastroenterology, Bambino Gesù Children's Hospital, Rome, Italy.
J Pediatr Surg. 2003 May;38(5):819-23. doi: 10.1016/jpsu.2003.50174.
BACKGROUND/PURPOSE: The authors' 15-year experience with children shows a high percentage of recurrence of functional constipation (FC) with conventional treatment. These data, confirmed in the international literature, led them to develop a new therapeutic approach. The aim of this study was to achieve intestinal control and avoid recurrence of FC in children through use of medical-psychological treatment.
The authors studied 25 children (18 boys; mean age, 4.7 years; range, 2.10 to 7), 20% of whom had anal fissure, 30% retentive soiling, 52% pain on defecation, and 88% fecal retention owing to FC. Children and parents were questioned about eating and sleeping habits, school, toilet training, and daily routine. Treatment included increasing water and fiber intake, laxatives, and family therapy including making rules and working on autonomy and paternal role.
Mean onset of FC was 3.5 years, after "stressful events" in 88%. The questionnaire shows that 68% lacked parental autonomy and authority; 84% of children decided on their own about eating habits and sleeping; 68% had a "peripheral" father with a mother-child symbiotic relationship. After one month of therapy, 92% of children showed a modification of at least 2 behavioral patterns; after 3 months, 88% had regular bowel movements. During follow-up (range, 6 to 28 months), 48% had 2 or 3 recurrent episodes. After one year, 68% had reinforced the new behavioral patterns with resolution of the pathologic aspects.
A multidisciplinary approach in the treatment of childhood functional constipation showed consistent therapeutic results by making rules and by equalizing family roles.
背景/目的：作者对儿童长达15年的研究表明，传统治疗方法下功能性便秘（FC）的复发率很高。这些数据在国际文献中得到证实，促使他们开发一种新的治疗方法。本研究的目的是通过医学心理治疗实现儿童肠道控制并避免FC复发。
作者研究了25名儿童（18名男孩；平均年龄4.7岁；范围2.10至7岁），其中20%有肛裂，30%有大便失禁，52%排便时疼痛，88%因FC出现粪便潴留。对儿童及其父母询问了饮食和睡眠习惯、学校情况、如厕训练和日常生活。治疗包括增加水和纤维摄入量、使用泻药以及家庭治疗，包括制定规则、培养自主性和明确父亲角色。
FC的平均发病年龄为3.5岁，88%发生在“应激事件”之后。调查问卷显示，68%的儿童缺乏父母的自主性和权威性；84%的儿童自行决定饮食习惯和睡眠；68%的儿童有一位“边缘化”的父亲，存在母婴共生关系。治疗一个月后，92%的儿童至少有2种行为模式得到改善；3个月后，88%的儿童排便规律。在随访期间（范围6至28个月），48%的儿童有2至3次复发。一年后，68%的儿童强化了新的行为模式，病理方面得到解决。
儿童功能性便秘的多学科治疗方法通过制定规则和平衡家庭角色显示出一致的治疗效果。
