von Gontard Alexander, Claßen Martin
Psychiatrische Dienste Graubünden, Ambulante Dienste für Kinder- und Jugendpsychiatrie, Chur, Schweiz.
Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Z Kinder Jugendpsychiatr Psychother. 2023 May;51(3):233-250. doi: 10.1024/1422-4917/a000920. Epub 2023 Jan 19.
Functional Constipation and Nonretentive Fecal Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Constipation and fecal incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. Functional constipation and nonretentive fecal incontinence can be differentiated according to the current Rome-IV classification systems. This interdisciplinary guideline aims to summarize the current state of knowledge regarding somatic and psychiatric assessment and treatment. It formulates consensus-based, practical recommendations. The members of the Guideline Commission consisted of 11 professional associations and a parental organization. The guideline was based on current literature searches, several online surveys, and consensus conferences based on standard procedures. Functional constipation is much more common than nonretentive fecal incontinence. Constipation requires a detailed medical assessment to exclude somatic causes, especially in young children. Red flags are useful indicators of organic causes to be considered. Most cases of constipation are functional (approximately 95 %). Counseling, toilet training, disimpaction, and long-term oral laxatives, combined with cognitive-behavioral interventions, are most effective. The assessment and treatment of nonretentive fecal incontinence are similar. The rate of somatic factors is much lower (approximately 1 %). Laxatives can worsen outcomes and should be avoided. Comorbid psychological disorders are common (approximately 30 % to 50 %). They should be assessed and treated additionally according to evidence-based guidelines. The recommendations of this guideline were approved with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required, especially regarding nonretentive fecal incontinence.
评估与治疗临床指南 便秘和大便失禁是儿童和青少年的常见疾病，与功能丧失及高并发心理障碍发生率相关。功能性便秘和非潴留性大便失禁可根据当前的罗马IV分类系统进行区分。本跨学科指南旨在总结有关躯体和精神评估及治疗的当前知识状况。它制定基于共识的实用建议。指南委员会成员包括11个专业协会和一个家长组织。该指南基于当前的文献检索、多项在线调查以及基于标准程序的共识会议。功能性便秘比非潴留性大便失禁更为常见。便秘需要详细的医学评估以排除躯体原因，尤其是在幼儿中。警示信号是需要考虑的器质性原因的有用指标。大多数便秘病例是功能性的（约95%）。咨询、排便训练、解除粪嵌塞以及长期口服泻药，并结合认知行为干预，最为有效。非潴留性大便失禁的评估和治疗与之相似。躯体因素的发生率要低得多（约1%）。泻药会使结果恶化，应避免使用。并发心理障碍很常见（约30%至50%）。应根据循证指南对其进行额外评估和治疗。本指南的建议获得了高度共识。跨学科合作尤为重要，因为需要考虑躯体因素以及并发的心理障碍和症状。需要更多研究，尤其是关于非潴留性大便失禁的研究。
