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Do Enemas Help Nonretentive Encopresis?

May 17, 2013 6:57 am

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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Do Enemas Help Nonretentive Encopresis?

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