14781-koppen

272 Chapter 13 Intractable FC is a difficult and frustrating problem with a detrimental effect on quality of life. In the majority of children with constipation, conservative treatment including toilet training, dietary advices, and oral laxatives is sufficient. In <10% of our tertiary population, however, invasive treatment such as rectal irrigation is necessary to treat these children and prevent them from undergoing surgery. To date, the present study describes the largest population of children with FC using transanal irrigation. The results of our study are in accordance with previous studies demonstrating that transanal colonic irrigation with Peristeen® may be an effective treatment modality for children with constipation and/or fecal incontinence due to organic causes. 11–15 Furthermore the results of the present study are in accordance with 2 smaller studies assessing the use of Peristeen® in children with FC. 10,17 In a small retrospective study of 10 children (7 children with FC) using Peristeen®, an improvement of fecal incontinence was observed in all children. 10 In that study, fecal incontinence symptoms were assessed using the fecal continence scoring system designed by Rintala and Lindahl 18 ; this score ranges from 1 to 20, with higher scores reflecting better outcome. The authors describe a significant improvement in the mean fecal incontinence score from 9.7 before treatment to 14.8 after treatment. Especially scoring items regarding social problems related to fecal incontinence improved. 10 In a more recent study using a prospectively maintained database, Ng et al. 17 evaluated the use of transanal irrigation (Peristeen® or Qufora®) in a mixed population of 42 children with constipation (26 children with FC). They also demonstrated a significant improvement in fecal continence score using the same scoring system and a significant increase in quality of life measured with the PedsQL 4.0 Generic Core Scales questionnaire. In accordance with these results, an improvement in quality of life has also been reported in studies evaluating children treated with Peristeen® for defecation disorders due to organic causes. 12,19 At the time of our survey, fecal incontinence had resolved in only 41% of children who were still using Peristeen®. According to the majority of parents, Peristeen® had, however, led to an improvement of symptoms compared to previous treatment regimens. The fact that these children, who would otherwise have undergone invasive surgery, are now treated with a nonsurgical approach in the home setting with high parental satisfaction rates is of substantial clinical importance. Peristeen® can be regarded as a safe option for colonic irrigation in children with intractable constipation. Aside from pain, no severe adverse events have been reported by the parents participating in our study. This is in accordance with previous studies in children using Peristeen. 10–17 Pain and discomfort seem to be the most occurring adverse events and are reported throughout studies as reason for cessation of treatment. 17 In addition, based on our experience, we would not recommend transanal irrigation for children with severe anxiety problems, because treatment via an anorectal route may enhance anxiety