P0470 EFFICIENCY OF BIOFEEDBACK THERAPY FOR PEDIATRIC CHRONIC CONSTIPATION

Introduction: The basic therapeutic strategies of soiling have been stool softener, diet and exercise therapies in pediatric chronic constipation. The biofeedback therapy which is based on biobehavioral theory is widely used in adult patients with pelvic floor dyssynergia(PFD). But, the biofeedback therapy has been rarely considered in pediatric constipation because of poor cooperation and physician’s fixed idea that pediatric constipation has good prognosis mostly. Recent well-developed anorectal function tests show obvious PFD pattern in some pediatric constipation, and we studied with idea that biofeedback therapy will be proper treatment modality in PFD children. Methods: Seventeen children complained of constipation and/or soiling from September, 2002 to August, 2003. Defecography, anorectal manometry, balloon expulsion test and intra-anal EMG on defecation were carried out prior to treatment. Biofeedback therapy was fulfilled for about 20 minutes each time two or three times a week basically. Treatment was finished when more than 3 times a week of defecation times or the improvement of constipation for ROME II criteria, or normal anorectal cooperation appeared. Balloon expulsion test and intra-anal EMG were also done on the end of treatment. A change of stool nature following ‘Bristol scale stool form’, defecation times weekly, continuance or discontinuance of medication, and so on were examined with questionnaire. Results: Biofeedback was applied successfully in 13 of 17 children (mean age: 8 years), whereas it failed in 4 of 17 children (mean age: 4 years) due to poor cooperation. Chief complaints among 13 children were soiling (6 children), constipation with soiling (5) and constipation (2). On defecogram, 10 patients (77%) were suspected of PFD, 2 patients (15%) were normal, and one patient did not cooperate. On anorectal manometry, 7 patients (54%) showed pattern of paradoxical anal contraction, one patient (8%) presented failure of anal relaxation, 4 patients (31%) were normal pattern, and one was not cooperative. On intra-anal EMG, all of the 13 showed paradoxical anal contraction. On balloon expulsion test, 10 (71%) failed in defecation. Median times of application of Biofeedback therapy was 6 times. On EMG after treatment, all of the 13 show good anorectal cooperation and 7 (70%) of 10 patients who failed in previous balloon expulsion test could expel balloon. In 11 patients who had stool softener, 8 (73%) patients could suspend or reduce dosage of pills. Conclusion: We showed that biofeedback therapy was effective on the treatment of pediatric constipation and many of them showed PFD. However, it was difficult to apply biofeedback for younger children less than 5 years old.