Muddasani S, et al. – The efficacy of physical therapy (PT) was examined for fecal incontinence in children with pelvic floor dyssynergia (PFD). Outcomes revealed that in the majority of children with fecal incontinence related to PFD, pelvic floor PT was effective. Factors associated with PT efficacy included improved PFM functioning, good compliance with PT, and history of tethered cord.

Methods

• This study consisted of children with PFD completing >1 PT session for fecal incontinence at a quaternary children's hospital.
• At baseline and at the final PT visit, the frequency of fecal incontinence (primary outcome), constipation–related medication use, number of bowel movements (in those with <3 per week at baseline) and pelvic floor muscle (PFM) function were captured.
• Outcomes were categorized as excellent (complete continence), good (>50% decrease in fecal incontinence frequency), fair (not worsening but <50% fecal incontinence frequency decrease), and poor (more frequent fecal incontinence).
• With the percentage of attended PT appointments, compliance with PT was evaluated.

Results

• Enrolled children met the following primary outcomes: 27 (42.2%) excellent, 24 (37.5%) good, 11 (17.1%) fair, and 2 (3.1%) poor.
• Factors associated with an excellent or good outcome included improved PFM functioning and good (≥70% PT attendance) compliance.
• Investigations suggested that children with a history of surgically corrected tethered spinal cord were more likely to have a fair outcome (P = .015).
• Use of constipation–related medications decreased (1.9 ± 0.7 vs 1.5 ± 0.9, P = .005).
• Weekly bowel movement frequency increased (1.6 ± 0.6 vs 6.4 ± 4.8, P < .001) in those with infrequent bowel movements (n = 26) at baseline.