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ABSTRACT Background: Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. Objective: To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). Methods: Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 "pilot" children). Results: Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 "pilot" children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. Conclusion: In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them.
RESUMO Contexto: Constipação funcional e enurese frequentemente coexistem. Tratamento da constipação geralmente resulta em cura ou melhora da enurese. Entretanto, além da apresentação clássica, pode ocorrer constipação oculta (CO), diagnosticada por exame subsidiário; ademais, ao aplicar questionário detalhado, pode-se detectar constipação semioculta (CSO). Objetivo: Obter as frequências de CO e CSO em crianças com enurese mono- ou não monossintomática (EMN ou ENMN). Métodos: Crianças/adolescentes saudáveis, exceto por enurese refratária à terapia comportamental, e que negavam constipação após perguntas simples, respondiam a questionário estruturado sobre hábito intestinal, e realizavam radiografia simples de abdômen. A constipação foi classificada considerando os critérios diagnósticos de Boston (que permitem diagnóstico em fases iniciais) e retenção fecal na radiografia quantificada ≥10 pelo escore de Barr. As crianças com constipação receberam tratamento padronizado (exceto 26 crianças "piloto"). Resultados: Das 81 crianças, 80 com idade 9,34±2,07 anos, 52,5% masculinas, foram diagnosticadas com constipação: 30 CO, 50 CSO; 63.75% tinham EMN, 36.25% ENMN (6 ENMN sem terapia comportamental). Os dados demográficos e o escore de Barr foram semelhantes para CO e CSO, mas as crianças com CSO apresentaram significativamente mais complicações de constipação (incontinência fecal retentiva e/ou dor abdominal recorrente). A não apresentação da Escala Fecal de Bristol (EFB) para 24 crianças "piloto", ou ausência de sintomas de constipação acompanhando EFB predominantemente do tipo 3, em 13 crianças, não teve impacto significativo na detecção de constipação pelo escore de Barr. Crianças que identificaram EFB 3 ou ≤2 tiveram resultados semelhantes. Vinte e oito crianças, com acompanhamento adequado após o tratamento, melhoraram ou se recuperaram da constipação em 44 de seus 52 retornos. Conclusão: Em pacientes com EMN ou ENMN refratária à terapia comportamental, e que inicialmente negavam constipação após perguntas simples, questionário baseado nos critérios diagnósticos de Boston detectou CSO em 61.7%, e o escore radiológico de Barr revelou retenção fecal (CO) em 37% deles.
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PURPOSE: We have assessed the clinical usefulness of solid maker transit technique and Barr-score in 31 patients with idiopathic constipation (male:female; 17:14, mean age; 6.7 years, range 1.4-12 years). METHODS: All patients underwent full history taking and physical examination including rectal examination. On first visit to gastroenterology clinic a plain abdominal film was taken for Barr-score which evaluated by two observers without the information of the patients. Kappa score was calculated for inter or intra observer variability. Sitz marker were given orally at 9 am on days 1, 2 and 3, and another plain abdominal film was taken on day 5. Total remained solid marker were counted for the degree of retention. We calulated the residual sitz marker. Each film was divided into right colon, left colon and rectosigmoid areas, using bony landmarks, and the marker content of each area counted. RESULTS: 2 patients were excluded because they resisted to take sitz maker. Transit times were normal, mild, moderate and severe delay in 12 patients, 2 patients, 3 patients and 12 patients respectively on day 5 film. The correlation coefficiency between the degree of transit delay and clinical severity was 0.89. Among 14 patients with transit delay, 12 patients has outlet obstruction, 1 patient right colonic delay and 1 patients left colonic delay. The Kappa for inter and intra-personal variability were 4.13 and 4.18 respectively (moderate consistency each). The correlation coefficiency between Barr-score and solid marker colonic transit time was 0.603 (P=0.0008). CONCLUSIONS: This results showed that the solid marker colonic transit time and Barr score were useful in evaluation of patients with constipation.