No –according to a recent study (J Pediatr 2013; 162: 1023-7).
In this study, 71 children (76% boys, median age 9 years) with functional nonrententive fecal incontinence (FNRFI) were randomized to receive conventional therapy (control group) or conventional therapy along with daily enemas for 2 weeks. Conventional therapy was considered education, toilet training, behavioral strategies, and a daily bowel diary with reward system. All children were instructed to defecate on toilet for 5 minutes after each meal. Treatment success was defined as <2 episodes of fecal incontinence (FI) per month. Outcomes were measured at 6 weeks, 12 weeks, 6 months, and 12 months after the start of treatment.
Results:
- At the start, median FI was 6.1 per week and median defecation frequency was 7.0 per week.
- In both the control group and the treatment group, there was improvement. After the initial 6 weeks of treatment, FI episodes were 2.0/week in the control group and 1.0/week in the treatment group.
- The treatment success at long-term followup was 17% for both groups.
In the discussion, the authors note that a longer course of enemas (> 3 months) could be needed to improve long-term outcomes. They also note a high rate of daytime (31%) and night time (35%) urinary incontinence in these children; “we hypothesize that children with FNRFI not only deny or neglect their urge to defecate but exhibit the same behavior toward micturation.”
Take-home message: Both treatments improved the frequency of FI (and urinary incontinence); however, neither were highly effective. Short-term use of enemas is not likely to have a meaningful effect. Better treatment strategies are needed.
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