Center for Neurointestinal Health, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital for Children Boston, Boston, Massachusetts, USA,
Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Dig Dis. 2019;37(6):478-485. doi: 10.1159/000500121. Epub 2019 May 16.
Chronic constipation is a common childhood problem and often caused or worsened by abnormal dynamics of defecation. The aim of this study was to assess the benefit of pelvic floor physical therapy (PFPT), a novel treatment in pediatrics for the treatment of chronic constipation with dyssynergic defecation.
This was a retrospective study of 69 children seen at a pediatric neurogastroenterology program of a large tertiary referral center for chronic constipation and dyssynergic defecation, determined by anorectal manometry and balloon expulsion testing. We compared the clinical outcome of patients who underwent PFPT (n = 49) to control patients (n = 20) whom received only medical treatment (laxatives/stool softeners). Additionally, characteristics of the treatment group were analyzed in relation to therapeutic response.
Thirty-seven (76%) of the patients who received physical therapy had improvement in constipation symptoms, compared to 5 (25%) of the patients on conservative treatment (p < 0.01). Additionally, patients who received pelvic physical therapy had fewer hospitalizations for cleanouts (4 vs. 25%, p = 0.01) and -colonic surgery than those that were treated with medical therapy exclusively (0 vs. 10%, p = 0.03). Among the patients who received physical therapy, those that suffered from anxiety and/or low muscle tone had a higher response rate (100%). There were no adverse effects from the intervention.
The new field of pediatric PFPT is a safe and effective intervention for children with dyssynergic defecation causing or contributing to chronic constipation, particularly in children whose comorbidities include anxiety and low -muscle tone.
慢性便秘是儿童常见的问题，通常由排便异常动力学引起或加重。本研究旨在评估盆底物理疗法（PFPT）对伴有协同性排便障碍的慢性便秘的治疗效果，PFPT 是儿科领域一种新的治疗方法。
这是一项回顾性研究，纳入在一家大型三级转诊中心的儿科神经胃肠病学计划中就诊的 69 名慢性便秘和协同性排便障碍患儿，这些患儿通过肛门直肠测压和球囊排出试验确定存在排便障碍。我们比较了接受 PFPT（n=49）和仅接受药物治疗（泻药/大便软化剂）的对照组（n=20）患儿的临床疗效。此外，还分析了治疗组的特征与治疗反应之间的关系。
接受物理治疗的 37 名（76%）患儿便秘症状改善，而仅接受保守治疗的 5 名（25%）患儿症状改善（p<0.01）。此外，接受盆底物理治疗的患儿因清洁灌肠（4 例 vs. 25%，p=0.01）和结肠切除术（0 例 vs. 10%，p=0.03）的住院次数少于仅接受药物治疗的患儿。在接受物理治疗的患儿中，患有焦虑和/或低肌张力的患儿的反应率更高（100%）。干预措施无不良反应。
儿科 PFPT 是一种安全有效的干预方法，适用于伴有协同性排便障碍引起或加重的慢性便秘的儿童，特别是伴有焦虑和低肌张力等并发症的儿童。
