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Constipation and fecal incontinence in children with cerebral palsy : overview of literature and flowchart for a stepwise approach

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Abstract
Background and study aims : Constipation and fecal incontinence are common problems in neurologically impaired children. This paper aims to give an overview on bowel problems in cerebral palsy children and to suggest a stepwise treatment approach. A pubmed search was performed looking at studies during the past 20 years investigating bowel problems in neurologically disabled children. Results : The search revealed 15 articles. Prevalence and presentation was the subject of 8 papers, confirming the importance of the problem in these children. The other papers studied the results of different treatment modalities. No significant differences between treatment modalities could be demonstrated due to small studied cohorts. Therefore, no specific treatment strategy is currently available. An experienced based stepwise approach is proposed starting with normalization of fiber intake. The evaluation of the colon transit time could help in deciding whether desimpaction and eventually laxatives including both osmotic (lactulose, macrogol) as well as stimulant laxatives might be indicated. Or, in case of fast transit loperamide or psyllium can be tried. Surgery should be a last resort option. Conclusion : Studies investigating constipation and continence in neurologically impaired children are scarce, making it difficult to choose for the optimal treatment. A stepwise treatment approach is proposed, measuring the colon transit time to guide treatment choices.
Keywords
urinary incontinence, fecal incontinence, children cerebral palsy, stepwise approach, COLONIC TRANSIT-TIME, GASTROINTESTINAL PROBLEMS, PREVALENCE, ADULTS

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MLA
Vande Velde, Saskia et al. “Constipation and Fecal Incontinence in Children with Cerebral Palsy : Overview of Literature and Flowchart for a Stepwise Approach.” ACTA GASTRO-ENTEROLOGICA BELGICA 81.3 (2018): 415–418. Print.
APA
Vande Velde, S., Van Renterghem, K., Van Winckel, M., De Bruyne, R., & Van Biervliet, S. (2018). Constipation and fecal incontinence in children with cerebral palsy : overview of literature and flowchart for a stepwise approach. ACTA GASTRO-ENTEROLOGICA BELGICA, 81(3), 415–418.
Chicago author-date
Vande Velde, Saskia, Katrien Van Renterghem, Myriam Van Winckel, Ruth De Bruyne, and Stephanie Van Biervliet. 2018. “Constipation and Fecal Incontinence in Children with Cerebral Palsy : Overview of Literature and Flowchart for a Stepwise Approach.” Acta Gastro-enterologica Belgica 81 (3): 415–418.
Chicago author-date (all authors)
Vande Velde, Saskia, Katrien Van Renterghem, Myriam Van Winckel, Ruth De Bruyne, and Stephanie Van Biervliet. 2018. “Constipation and Fecal Incontinence in Children with Cerebral Palsy : Overview of Literature and Flowchart for a Stepwise Approach.” Acta Gastro-enterologica Belgica 81 (3): 415–418.
Vancouver
1.
Vande Velde S, Van Renterghem K, Van Winckel M, De Bruyne R, Van Biervliet S. Constipation and fecal incontinence in children with cerebral palsy : overview of literature and flowchart for a stepwise approach. ACTA GASTRO-ENTEROLOGICA BELGICA. 2018;81(3):415–8.
IEEE
[1]
S. Vande Velde, K. Van Renterghem, M. Van Winckel, R. De Bruyne, and S. Van Biervliet, “Constipation and fecal incontinence in children with cerebral palsy : overview of literature and flowchart for a stepwise approach,” ACTA GASTRO-ENTEROLOGICA BELGICA, vol. 81, no. 3, pp. 415–418, 2018.
@article{8580813,
  abstract     = {Background and study aims : Constipation and fecal incontinence are common problems in neurologically impaired children. This paper aims to give an overview on bowel problems in cerebral palsy children and to suggest a stepwise treatment approach. A pubmed search was performed looking at studies during the past 20 years investigating bowel problems in neurologically disabled children. 
Results : The search revealed 15 articles. Prevalence and presentation was the subject of 8 papers, confirming the importance of the problem in these children. The other papers studied the results of different treatment modalities. No significant differences between treatment modalities could be demonstrated due to small studied cohorts. Therefore, no specific treatment strategy is currently available. An experienced based stepwise approach is proposed starting with normalization of fiber intake. The evaluation of the colon transit time could help in deciding whether desimpaction and eventually laxatives including both osmotic (lactulose, macrogol) as well as stimulant laxatives might be indicated. Or, in case of fast transit loperamide or psyllium can be tried. Surgery should be a last resort option. 
Conclusion : Studies investigating constipation and continence in neurologically impaired children are scarce, making it difficult to choose for the optimal treatment. A stepwise treatment approach is proposed, measuring the colon transit time to guide treatment choices.},
  author       = {Vande Velde, Saskia and Van Renterghem, Katrien and Van Winckel, Myriam and De Bruyne, Ruth and Van Biervliet, Stephanie},
  issn         = {1784-3227},
  journal      = {ACTA GASTRO-ENTEROLOGICA BELGICA},
  keywords     = {urinary incontinence,fecal incontinence,children cerebral palsy,stepwise approach,COLONIC TRANSIT-TIME,GASTROINTESTINAL PROBLEMS,PREVALENCE,ADULTS},
  language     = {eng},
  number       = {3},
  pages        = {415--418},
  title        = {Constipation and fecal incontinence in children with cerebral palsy : overview of literature and flowchart for a stepwise approach},
  volume       = {81},
  year         = {2018},
}

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