Enemas can help children with voiding problems

NEW YORK (Reuters Health) - Urination problems coupled with chronic constipation in children can be cured by enemas, according to the results of a Dutch study in the journal Urology.

Children with this problem, also referred to as "dysfunctional voiding," can have a variety of symptoms including urgent urination, frequent urination, and incontinence. Children with the disorder are at increased risk for urinary tract infections. Treatment of the disorder depends on the underlying cause and may include a combination of behavioral, biofeedback, and medical interventions.

"Dysfunctional voiding sometimes coincides with long-lasting defecation disturbances," Dr. Rafal Chrzan and colleagues from University Children's Hospital UMC Utrecht, the Netherlands, write. "This condition is called dysfunctional elimination syndrome," they note. "The term indicates that chronic constipation can coexist with dysfunctional voiding with urinary tract infections and/or incontinence."

The researches examined the use of colonic enemas in 50 children with dysfunctional voiding and chronic constipation. Treatment consisted of filling the rectum with water once daily for 2 weeks, then three times per week for 6 months.

Thirty patients (60 percent) experienced total relief of urinary tract symptoms during follow-up. Eight patients developed at least one urinary tract infection during follow-up, and 12 subjects were free of urinary tract infection but still experienced some difficulties in voiding.

Constipation improved in all of the children. Enemas were stopped with continuing success in 33 patients. Relapse of constipation in 17 patients resulted in the need for chronic, intermittent enema therapy.

"Five patients (10 percent) reported abdominal pain during enema at the beginning of the treatment. However, this did not lead to discontinuation of the enema treatment," Chrzan and colleagues report. "We noted no serious counter-effect."

They say a trial is now being conducted at their institution to compare enemas with biofeedback training as primary treatment for constipated children with dysfunctional voiding.

SOURCE: Urology, April 2008.