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Abstract

Background Encopresis, fecal soiling is often secondary to functional constipation and retention. It is significantly impact a child's psychological health as it can result in feelings of shame, social isolation, and low self-esteem and negatively affect their quality of life and their families. Objective To evaluate and compare the efficacy and safety of interferential stimulation (IF) applied on sigmoid colon and anorectal neuromuscular electrical stimulation (NMES), in combination with behavioral therapy and pelvic floor muscle training (PFMT), in improving continence outcomes in children with secondary encopresis refractory to laxatives. Methods In this comparative randomized controlled clinical trial, 30 children (5–10 years) with secondary encopresis; children with fecal soiling after achieving at least 6 months of complete fecal continence of toilet-trained child, with a history of functional constipation diagnosed by Rome IV Criteria, infrequent bowel movements, and refractory to laxatives. They were assigned to three groups; control group (G a) receiving behavioral therapy plus PFMT and two study groups receiving the same control group interventions plus sigmoid colon IF for (G b), and anorectal NMES for (G c), three times per week for 12 weeks. Primary outcomes included anal sphincter muscle activity peak (mmHg), weekly voluntary bowel movements frequency, weekly fecal soiling frequency, and stool consistency by Bristol stool form scale (BSFS). Measurements were taken at baseline and post-intervention using anal pressure sensor and standardized bowel diaries. Results All groups showed significant within-group improvements (p < 0.05) in all outcomes. However, the two study groups demonstrated significantly greater post-treatment gains compared with controls with more improvement for anorectal NMES (G c). No adverse events were reported. Conclusion Both IF stimulation of sigmoid colon and anorectal NMES are safe and effective adjunct to behavioral therapy and PFMT for improving encopresis in children with functional constipation, they improve the stool consistency assessed by BSFS. Anorectal NMES is the most effective in improving all measured outcomes. These findings support its inclusion in pediatric bowel management protocols, particularly for refractory cases. Larger multicenter trials with long-term follow-up and patient-reported outcomes are warranted to confirm these benefits and optimize treatment parameters.

Article Type

Original Study

Subject Area

Physical Therapy

IRB Number

HB000142

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

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