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Journal of Autism and Developmental... Dec 2021The purpose of this study was to investigate the effects of an intensive toilet training program on continence and self-initiation for elementary children with autism...
The purpose of this study was to investigate the effects of an intensive toilet training program on continence and self-initiation for elementary children with autism spectrum disorder (ASD). Researchers used a non-concurrent multiple baseline design (Watson and Workman in J Behav Ther Exp Psychiatry 12:257-259, 1981, https://doi.org/10.1016/0005-7916(81)90055-0 ) with regulated randomization (Koehler and Levin in Psychol Methods 3(2):206, 1998, https://doi.org/10.1037/1082-989X.3.2.206 ) to evaluate the effects of the intensive protocol with four students with ASD in the classroom where they received special education services. The protocol included increased access to fluids, contingent time intervals for sit schedules, programmed reinforcement, and dry checks. All four participants met mastery criteria and maintained independent toileting after the study's completion. Three participants began self-initiating to use the restroom. The implications and recommendations for future research are discussed.
Topics: Autism Spectrum Disorder; Child; Education, Special; Humans; Reinforcement, Psychology; Students; Toilet Training
PubMed: 33506373
DOI: 10.1007/s10803-021-04883-3 -
The Permanente Journal 2017Atypical defecation habits are common and distressing for children and families and can have a major impact on quality of life. Often, no underlying factor can be... (Review)
Review
CONTEXT
Atypical defecation habits are common and distressing for children and families and can have a major impact on quality of life. Often, no underlying factor can be identified, and the defecation disorder is considered functional. Current interventions are not successful for up to 50% of children. We suggest this high failure rate may be caused by lack of consistency in descriptors of behavioral indicators for functional defecation problems. Most investigations and descriptors focus on general behavior. There are fewer reports concerning defecation-specific behaviors.
OBJECTIVE
To develop a thorough inventory of defecation-specific behaviors, providing a more informed foundation for assessment and intervention.
DESIGN
A systematic review of six common databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Reference lists of retained articles were screened for additional studies.
MAIN OUTCOME MEASURES
Content analysis was used to classify defecation-specific behaviors into 17 categories.
RESULTS
Our search yielded 2677 articles; 98 peer-reviewed publications were retained for full-text review, and 67 articles were included in the final qualitative synthesis. Although there is inconsistency in reported diagnostic criteria, stool withholding and manifesting pain on defecation are the most commonly reported defecation-specific behaviors. In the studies that included children with autism or attention-deficit/hyperactivity disorder, the defecation-specific behaviors were not unique to the diagnostic group.
CONCLUSION
Consistent use of established diagnostic criteria, along with use of behaviors identified through this review, lay a foundation for more effective interventions.
Topics: Adolescent; Child; Child Behavior; Child, Preschool; Constipation; Defecation; Encopresis; Fecal Incontinence; Female; Humans; Infant; Infant, Newborn; Male; Toilet Training
PubMed: 29035187
DOI: 10.7812/TPP/17-047 -
The Turkish Journal of Gastroenterology... Apr 2020An anal fissure (AF) is a linear tear in the distal anal canal and is one of the most common causes of anal pain. Hemorrhoidal disease (HD) is a symptomatic growth and...
BACKGROUND/AIMS
An anal fissure (AF) is a linear tear in the distal anal canal and is one of the most common causes of anal pain. Hemorrhoidal disease (HD) is a symptomatic growth and distal displacement of normal anal cushions. Numerous studies have addressed the contributing factors of these conditions, yet the results remain controversial. In this study, we hypothesize that increasing patients' awareness of hidden risk factors could reduce the rate of HD and AF.
MATERIALS AND METHODS
A questionnaire-based controlled study was planned. After power analysis, patients with HD (n=60) and AF (n=60) were enrolled consecutively into the study group and compared with the control group (n=60) of healthy individuals. The survey was designed to assess the participants' toilet and dietary habits and anxiety risk. Odds ratios were calculated and a binary logistic regression model was constructed to identify associated factors.
RESULTS
Hard stools, spending more than 5 minutes in the toilet, frequent straining during defecation, and increased spice intake were more frequent in the patients with HD; and hard fecal consistency, time elapsed in toilet greater than 5 min, straining during defecation, and high anxiety risk were more frequent in the patients with AF as compared to the control group (p<0.05).
CONCLUSION
Possible associations were identified between habitual factors or conditions (i.e., fecal consistency, the time elapsed in the toilet, straining during defecation) and anxiety and benign anorectal diseases (i.e., HD and AF). Patients should be advised about these hidden threats.
Topics: Adult; Anxiety; Case-Control Studies; Conservative Treatment; Cross-Sectional Studies; Defecation; Feeding Behavior; Female; Fissure in Ano; Hemorrhoids; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Patient Education as Topic; Surveys and Questionnaires
PubMed: 32412899
DOI: 10.5152/tjg.2020.19183 -
Translational Andrology and Urology Sep 2012The relationship between vesicoureteral reflux and bladder dysfunction is inseparable and has long been emphasized. However, the primary concern of all physicians... (Review)
Review
The relationship between vesicoureteral reflux and bladder dysfunction is inseparable and has long been emphasized. However, the primary concern of all physicians treating patients with vesicoureteral reflux is the prevention of renal scarring and eventual deterioration of renal function. Bladder dysfunction, urinary tract infection and vesicoureteral reflux are the three important factors which are closely related to each other and contribute to the formation of renal scar. Especially, there is ongoing discussion regarding the role of bladder dysfunction in the prognosis of both medically and surgically treated vesicoureteral reflux. The effect of bladder dysfunction on VUR is mostly via inadequate sphincter relaxation during infancy which is closer to immature bladder dyscoordination rather than true dysfunction. But after toilet training, functional obstruction caused by voluntary sphincter constriction during voiding is responsible through elevation in bladder pressure, thus distorting the architecture of bladder and ureterovesical junction. Reports suggest that voiding phase abnormalities in lower urinary tract dysfunction contributes to lower spontaneous resolution rate of VUR. However, filling phase abnormalities such as involuntary detrusor contraction can also cause VUR even in the absence of dysfunctional voiding. With regards to the effect of bladder dysfunction on treatment, meta-analysis reveals that the cure rate of VUR following endoscopic treatment is less in children with bladder bowel dysfunction but there is no difference for open surgery. The pathophysiology of bladder dysfunction associated with UTI can be explained by the 'milk-back' of contaminated urine back into the bladder and significant residual urine resulting from functional outlet obstruction. In addition, involuntary detrusor contraction can decrease perfusion of the bladder mucosa thus decreasing mucosal immunity and creating a condition prone to UTI. In terms of renal scarring, dysfunctional voiding seems to be more closely related to renal damage in association with VUR than overactive bladder. However, studies show that UTI can induce renal scarring even without VUR present and urodynamic abnormalities are quite often detected in these cases. Whether reflux of sterile urine in bladder dysfunction can cause significant renal scarring, especially when intrarenal reflux is present remains controversial. Another issue that warrants further research is the direct relationship between bladder dysfunction and renal scarring, since some reports suggest that these two conditions share a common genotype. Recently some studies have suggest VUR as a causal factor of bladder dysfunction, supported by the fact that bladder dysfunction resolves after injection therapy of VUR. Further study with more objective evaluation of bladder dysfunction may be needed.
PubMed: 26816705
DOI: 10.3978/j.issn.2223-4683.2012.06.09 -
The Turkish Journal of Gastroenterology... Jul 2021The initial treatment for fecal incontinence (FI) includes supportive treatment and medical treatment. If the initial treatment fails, biofeedback therapy (BFT) is...
BACKGROUND
The initial treatment for fecal incontinence (FI) includes supportive treatment and medical treatment. If the initial treatment fails, biofeedback therapy (BFT) is recommended. However, there are limited and conflicting results in the literature supporting the beneficial effect of BFT for FI. The aim of the study is to analyze the efficacy of BFT in 126 patients who have FI due to several causes.
METHODS
The data of 126 patients (88 females (69.8%) and 38 males (30.2%)) were collected retrospectively. Colonoscopy, anorectal manometry (ARM), and 3D-Endoanal ultrasonography (EAUS) were performed for all patients before applying BFT. In addition, all patients received toilet training instruction and training in Kegel and other pelvic floor strengthening exercises from an experienced nurse, before BFT.
RESULTS
The median age of participants was 54 years (range 18-75 years). While 80 patients (63.5%) had clinical and manometric benefit from BFT, 46 patients (36.5%) did not respond to BFT. According to the EAUS and ARM findings, BFT was beneficial in patients who had partial external sphincter failure, and was unsuccessful in patients who had both internal and external sphincter failure, both internal and external sphincter tears, and external sphincter tear rates of more than 25%. After BFT, significant increases in squeeze pressures were observed, with this increase being higher in the positive-response group.
CONCLUSION
The results suggest that BFT is effective in the treatment of FI for specific patient populations.
Topics: Adolescent; Adult; Aged; Biofeedback, Psychology; Colonoscopy; Electromyography; Exercise Therapy; Fecal Incontinence; Female; Humans; Male; Manometry; Middle Aged; Retrospective Studies; Toilet Training; Treatment Outcome; Ultrasonography; Young Adult
PubMed: 34464319
DOI: 10.5152/tjg.2021.20430 -
Jornal de Pediatria 2018Children with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to...
OBJECTIVES
Children with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to estimate the age toilet training starts and completes in children with DS compared to children with normal psychomotor development and to evaluate the method and type of toilet training most frequently used, as well as its association with lower urinary tract symptoms and functional constipation.
METHODS
A case-control study was carried out from 2010 to 2015. All parents completed a questionnaire designed to assess the toilet training process. Lower urinary tract symptoms were assessed through the application of the Dysfunctional Voiding Symptom Score. The presence of functional constipation was assessed according to the Rome III criteria.
RESULTS
The study included 93 children with Down syndrome and 204 children with normal psychomotor development (control group [CG]). The mean age of toilet training onset was 22.8 months in those with DS and 17.5 months in the CG (p=0.001). In children with DS, the mean age when completing toilet training was 56.2 months and 27.1 months in the CG (p=0.001). Among children with DS, females completed toilet training earlier (p=0.02). The toilet training method used most often was child-oriented approach in both groups. No association was observed with the presence of lower urinary tract symptoms or functional constipation and the age of beginning and completing toilet training in both groups.
CONCLUSION
Children with Down syndrome experienced prolonged toilet training time. Prospective longitudinal studies are essential to gain insight into the toilet training of these children.
Topics: Case-Control Studies; Child, Preschool; Constipation; Down Syndrome; Female; Humans; Male; Prospective Studies; Surveys and Questionnaires; Toilet Training
PubMed: 28869807
DOI: 10.1016/j.jped.2017.06.011 -
Italian Journal of Pediatrics Apr 2024Functional constipation is a common problem in childhood and has a great impact on social, physical, and emotional functioning of affected children and their caregivers.... (Review)
Review
Functional constipation is a common problem in childhood and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. No organic cause of the constipation can be found in approximately 95% of children, defining the "so-called" chronic functional constipation. Its prevalence has been reported to range from 0.7 to 29.6%, with a median of 12%. The diagnosis of functional constipation is exclusively clinical based on the pediatric diagnostic Rome criteria for functional gastrointestinal disorders and does not routinely require laboratory and/or radiological investigations. In case of alarm signs and symptoms that may suggest organic diseases, further investigations can be required. The therapeutic management is based on non-pharmacological and pharmacological approaches. Education, demystification of constipation and reward-based toilet training represent the cornerstones of nonpharmacological management. Disimpaction, maintenance treatment and weaning of medication are all elements of pharmacological treatment. Osmotic laxatives, mainly polyethylene glycol (PEG), are considered the first-choice laxative for both disimpaction and maintenance treatment. The aim of this review is to provide pediatric gastroenterologists with a practical tool to support the clinical and therapeutic management of children and adolescents affected by chronic functional constipation.
Topics: Humans; Constipation; Child; Adolescent; Laxatives; Chronic Disease
PubMed: 38649896
DOI: 10.1186/s13052-024-01623-y -
PloS One 2022Child feces are an important source of fecal exposure in household environments. Typically, one of two behaviors is necessary to mitigate this risk: either caregivers...
Child feces are an important source of fecal exposure in household environments. Typically, one of two behaviors is necessary to mitigate this risk: either caregivers dispose of their children's feces into a latrine or children learn how to use a latrine. Although past studies have examined factors associated with these two behaviors collectively (i.e. "safe disposal"), there is a need to separately analyze these distinctive practices to better inform programming. This study aims to quantitatively examine contextual and psychosocial factors influencing caregiver safe disposal and, separately, child latrine training. We surveyed 791 primary female caregivers, who reported on 906 children <5 years old, across 74 villages in rural Odisha, India. At their last defecation event, 38% of children used the latrine and another 10% had their feces safely disposed of into the latrine. Since caregiver safe disposal was rare, we instead assessed safe disposal intention. We used linear regression and multilevel mixed effects models to examine contextual and psychosocial factors. For contextual factors, we found caregivers had stronger safe disposal intention when they came from wealthier households and had greater informational support, but weaker intention when their latrine was near the household. Caregivers more intensely practiced latrine training with their child when they themselves used the latrine for defecation, the latrine was fully intact, and they had greater instrumental support. For psychosocial factors, caregivers had stronger safe disposal intention when their households expected them to practice safe disposal, they felt strongly committed to the behavior, and had a plan for what to do when faced with a water shortage. Caregivers more intensely taught their child how to use the latrine when they believed their child was at risk of becoming sick if they practiced open defecation (OD); viewed child OD as unbeneficial; liked teaching their child; personally felt it was important for the child's father to help; felt confident in their ability to teach their child; and had greater action control over their training practice. Interestingly, caregivers put less effort into latrine training when they felt more concerned for their child's safety when the child defecated outside. These findings underscore the critical need to separately assess unique child feces management (CFM) practices and also provide a road map for practitioners on the types of behavior change strategies to consider in their CFM programming.
Topics: Caregivers; Child; Child, Preschool; Feces; Female; Humans; India; Rural Population; Sanitation; Toilet Facilities
PubMed: 36083872
DOI: 10.1371/journal.pone.0274069 -
Urology Journal May 2019This study seeks to investigate the possibility the existence of a difference in terms of start and end dates of toilet training between term and preterm children as... (Comparative Study)
Comparative Study
PURPOSE
This study seeks to investigate the possibility the existence of a difference in terms of start and end dates of toilet training between term and preterm children as well as the possible determining factors.
MATERIALS AND METHODS
This study was conducted as a 5-year retrospective case (children born preterm-(32 to <37 weeks) - and control (children born at term (>37 weeks + 1 day)) study. The data were collected with a form consisted of questions about demographic data (12 questions) and toilet traning features (10 questions) through face-to-face interviews with the mothers. A chi-square test and logistic regression analysis were conducted to examine the data. Odds ratio was used as a measure of the relation between levels of the dependent variable. p< .01 and p< .05 values were assumed to be statistically significant.
RESULTS
The study examined a total of 133 children including 59 preterm children and 74 children born at term including 60 (45.1%) boys and 73 (54.9%) girls. The possibility of starting toilet training at or before 24 months was found to be 6.4 times greater in full-term children than preterm children (OR=6.493). The logistic regression analysis, which aimed at identifying any variables that might affect end date of toilet training, found that despite the tendency to consider preterm birth as a factor prolonging the duration of toilet training, the difference was not found to be statistically significant (p= .07).
CONCLUSION
This study compared full-term and preterm children in terms of start and end dates of toilet training and found that preterm children start toilet training later than full-term children. Based on the results of the study, it is possible to say that preterm birth, gender and birth order affect start date of toilet training. However there is no difference between term and preterm babies on the end date of toilet training.
Topics: Case-Control Studies; Female; Humans; Infant; Male; Premature Birth; Retrospective Studies; Term Birth; Time Factors; Toilet Training
PubMed: 31004337
DOI: 10.22037/uj.v0i0.4820 -
Nursing Outlook 2011This systematic literature review aimed to identify conservative interventions for reducing urinary incontinence (UI) in non-institutionalized frail older adults.... (Review)
Review
This systematic literature review aimed to identify conservative interventions for reducing urinary incontinence (UI) in non-institutionalized frail older adults. Randomized and quasi-experimental studies published in English reporting outcomes on UI frequency, severity, or quality of life were included and rated for quality. Studies reporting improvements over 50% in UI outcomes were considered clinically significant. Seven studies with 683 participants (75% female) were eligible. Multicomponent behavioral interventions including pelvic floor muscle exercises and bladder training had the strongest evidence for reducing UI. The evidence supporting comprehensive geriatric assessment with multicomponent behavioral interventions, pattern urge response training, and toilet skills was limited. There is insufficient evidence to derive firm conclusions regarding the use of conservative interventions. Clinical trials are needed on a variety of interventions to guide practice on UI prevention and management in frail community-dwelling older adults.
Topics: Aged; Evidence-Based Medicine; Frail Elderly; Humans; Independent Living; Randomized Controlled Trials as Topic; Urinary Incontinence
PubMed: 21757078
DOI: 10.1016/j.outlook.2011.05.010