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Pediatrics. 1997 Jan;99(1):50-3.
Behavioral characteristics of children with stool toileting refusal.

Blum NJ, Taubman B, Osborne ML.

Division of Child Development and Rehabilitation, Children's Seashore House, University of Pennsylvania, School of Medicine, Philadelphia 19104, USA.

OBJECTIVE: To determine if children with stool toileting refusal have more behavior problems than matched children who are toilet trained. DESIGN: Case-control study. SETTING: Suburban private pediatric practice. PARTICIPANTS: Children 30 to 48 months old who had achieved bladder control but refused to defecate on the toilet were identified as cases. Controls were sex- and age-matched children who were fully toilet trained. MEASURES: Total behavior problems were assessed using a semi-structured behavior screening interview with the child's parents. The parents also completed the Child Behavior Checklist for ages 2 to 4 and either the Toddler Temperament Scale (30 to 36 months old) or the Behavioral Style Questionnaire (36 to 48 months old). Child compliance with adult instructions was measured during a room clean-up task. RESULTS: Children with stool toileting refusal were not found to have more behavior problems than the matched children who were toilet trained. There were no differences between the two groups in compliance during the room clean-up task. There was a trend toward children with stool toileting refusal having a more difficult temperament, and these children were reported to have more problems with constipation and painful bowel movements than the controls. CONCLUSIONS: Children with stool toileting refusal do not have more behavior problems than controls who are toilet trained. Parents do report higher rates of constipation and painful defecation, but it is not clear whether this is a cause or effect of stool toileting refusal.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8989337&dopt=Abstract constipation laxative colon cleansing

Am J Gastroenterol. 1997 Jan;92(1):132-8.
Causes and management of recurrent biliary pain after successful nonoperative gallstone treatment.

Wehrmann T, Marek S, Hanisch E, Lembcke B, Caspary WF.

Department of Internal Medicine II, J. W. Goethe University Hospital, Frankfurt, Germany.

OBJECTIVE: To evaluate the frequency and causes of recurrent biliary colic after successful extracorporeal shock wave lithotripsy of gallstones. METHODS: Follow-up of 77 patients for 2 yr (median) after complete gallstone clearance by lithotripsy and adjuvant oral litholysis. All patients with recurrent biliary colic were examined thoroughly (laboratory data, ultrasonography, gastroscopy); the examination included gallbladder motility testing. If the patients suffered from additional gastrointestinal complaints, further symptom-guided investigations (pH-metry, lactose absorption study, enteroclysis, colonic transit time, colonoscopy) were performed. Patients without documented gallstone recurrence underwent ERCP and sphincter of Oddi manometry. Cholecystectomy was advised for patients in whom gallstones recurred, and patients with sphincter of Oddi dysfunction underwent endoscopic sphincterotomy. If other gastrointestinal disorders were diagnosed, appropriate treatment was initiated. RESULTS: Twenty-seven patients (35%) experienced biliary colic during follow-up. Gallstone recurrence was documented in 17 patients, and 16 of the patients who underwent cholecystectomy became symptom-free again (follow-up: 12 months). Gallbladder hypomotility was revealed in seven of the 17 patients with gallstone recurrence compared to none of the 10 patients without gallstone recurrence (p < 0.05). Microlithiasis was not detected in bile samples from the patients whose gallstones did not recur. Sphincter of Oddi dysfunction was found in four patients, and sphincterotomy cured all of them (follow-up: 9 months). Two of the remaining six patients had functional gastrointestinal disorders (reflux, constipation) and became asymptom

Eur J Pediatr Surg. 1996 Dec;6 Suppl 1:32-4.
Treatment of defecation disorders by colonic enemas in children with spina bifida.

Scholler-Gyure M, Nesselaar C, van Wieringen H, van Gool JD.

Spina Bifida Team, University Children's Hospital, Utrecht, The Netherlands.

Faecal incontinence and constipation are well known problems in children with spina bifida. Effective treatment can be difficult and this gave the condition a low priority despite the obvious physical and psychological sequelae. Positive experience with colonic enemas (CE) in the paediatric post-operative care have led us to adopt this method as the treatment of choice for defecation disorders in children with spina bifida. In 41 spina bifida children (mean age 8.4 years, range 7 months to 22 years), retrograde CEs with hand-warm tap water were given at home from once a day to twice per week. Satisfaction with the procedure was evaluated with a questionnaire sent out after a mean follow-up period of 33 months (range 6 to 55 months). The indications to start CEs were faecal incontinence (27%), constipation (27%) or both. 34% of 41 children also had other gastrointestinal complaints, 7% had headaches, 29% had poor appetite and 15% felt generally unwell. Before the start of CE 22% of the children had been on a diet, 37% on oral laxatives, 31% on a rectal laxative and 44% had to have manual evacuations. 90% used diapers on a daily basis. At the end of the follow-up period 27% of the children were still on a diet and 17% still used oral laxatives but rectal laxatives were no longer used nor were manual evacuations necessary. 66% of the 41 children were completely faecally continent and constipation occurred only occasionally, no child had faecal retention or impaction. At follow-up 39% still used diapers regularly and 20% used a panty-line and complaints of abdominal pain, headache and poor appetite were rare. Satisfaction with the procedure was rated highly by 63% of parents and children and good by 37% but 15% of the children found regul

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