Additive benefits of laxative, toilet training, and biofeedback therapies in the treatment of pediatric encopresis

Compared the additive benefits of laxative, behavior, and biofeedback treatments for encopresis, while attempting to identify treatment mechanisms and predictors of treatment outcome. 44 encopretic children, ages 6-15 years, were randomly assigned to either laxative therapy (LAX), LAX plus enhanced toilet training (ETT), or LAX + ETT + anal sphincter biofeedback (BF). Daily symptom diaries were completed 14 days before, upon initiation of, and 3 months follow-ing treatment initiation. ETT and BF were superior to LAX in reducing en-copresis. Outcome was significantly predicted by improvement during the initial 14 days of treatment. Reduction of soiling was associated with an increase in bowel movement frequency, and reductions in defecation pain and parental prompting to use the toilet. Because of its efficacy and minimal reliance on technology, ETT should be the initial treatment of choice. KEY WORDS: encopresis; laxatives; behavior therapy; biofeedback; prediction. The DSM-IV (American Psychiatric Association, 1994) defines encopresis as involuntary bowel movements, in inappropriate places, at a frequency of at least once a month for at least 3 months, for children ages 4 and older. With this 'We thank the National Institutes of Health for supporting this grant (ROl HD 28160), Dr. Loening-Baucke for the useful consultation, and those who agreed to participate in the study. 2A11 correspondence should be addressed to Daniel J. Cox, Behavioral Medicine Center, Box 223