"Dysfunctional voiding combined with chronic constipation can be cured by a course of colonic washout enemas, according to results of a Dutch study published in the April issue of
Urology. "Dysfunctional voiding sometimes coincides with long-lasting defecation disturbances," write Dr. Rafal Chrzan and colleagues from University Children's Hospital UMC Utrecht. "This condition is called dysfunctional elimination syndrome," they note. "The term indicates that chronic constipation can coexist with dysfunctional voiding with urinary tract infections and or/incontinence."
The researchers examined the use of colonic washout enemas in 50 children with dysfunctional voiding and persistent dilatation of the rectum despite cognitive bladder training and adequate oral laxatives. Treatment consisted of retrograde filling of the rectum with 20 mL water per kilogram body weight, starting once daily for two weeks, then three times per week for six months.
Thirty patients (60 per cent) experienced total relief of urinary tract symptoms during follow-up. Eight patients developed at least one urinary tract infection during follow-up, and 12 subjects were free of urinary tract infection but still experienced intermittent/staccato flow with residual volume more than ten per cent.
All of the children showed a normalized rectal diameter of less than 3.5 cm on ultrasound. Washout enemas were stopped with continuing success in 33 patients. Relapse of a distended rectum in 17 patients with persistent urinary tract symptoms resulted in the need for chronic intermittent enema therapy.
"Five patients (ten per cent) reported abdominal pain during enema at the beginning of the treatment. However, this did not lead to discontinuation of the enema treatment," Dr. Chrzan and colleagues report. "We noted no serious counter-effect."
They say a randomized clinical trail is now being conducted at their institution to compare enemas with biofeedback training as primary treatment for constipated children with dysfunctional voiding."
