Paediatric pelvic physiotherapy added to conventional treatment of functional constipation in children in primary care.

Constipation is the most common gastro-intestinal disorder in childhood. In a
survey among Dutch children constipation was in the top 20 most frequently
experienced complaints in the previous 14 days. The incidence of constipation
in general practice is 9.1 per 1000 registered children. Around 3% of children
referred to the general paediatrics* wards has constipation and this increases
up to 25% of children referred to a paediatric gastroenterologist. Education,
dietary advice, toilet training and laxative treatment (conventional therapy)
is currently recommended as the first choice therapy for children with
functional constiaption in primary care. However 3 *-5 years after the start of
medication treatment 52% -64% of the treated children still have constipation.
Paediatric pelvic physiotherapists claim to obtain good results with their
treatment and they already treat many children with functional constipation.
However because a lack of randomised controlled trials, paediatric pelvic
physiotherapy is not yet evidence-based. Therefore in this study the effect of
paediatric pelvic physiotherapy in addition to the conventional therapy will be
compared to conventional therapy alone for the treatment of functional
constipation in children in primary care.

The primary objective is to study the effect of paediatric pelvic physiotherapy
in addition to conventional therapy on the number of patients with treatment
success in children aged 4-17 years presenting in primary care with functional
constipation in comparison to conventional treatment alone.

Randomised controlled trial

The therapy (paediatric pelvic physiotherapy) will consist of education, toilet
training, breathing exercises, training of the pelvic floor muscles, training
of the abdominal muscles and abdominal massage. This will be added to the
standard advice and laxatives (conventional treatment) for the treatment of
functional constipation.

The total follow-up will be 8 months. Children who participate in the study are
asked to fill in a questionnaire at baseline, at 4 and 8 months follow-up.
Because this study compares two non-experimental and non-invasive treatment
options for childhood functional constipation it won*t impose an risk on
participating children. Furthermore for this study children only have to fill
in questionnaires which doesn't impose an extra risk on the participating
children.

If paediatric pelvic physiotherapy in addition to the conventional treatment is
successful for childhood functional constipation it can lead to less medication
use, an improved quality of life, less productivity losses of parents and less
referrals to the paediatrician.

Because the criteria for childhood constipation and the aetiology of childhood
constipation, like the approach of parents and the toilet trainedness, are
different from the aetiology of adulthood constipation, children will be
included in this study. Furthermore the treatment given by the paediatric
pelvic physiotherapist differ from the treatment given by a pelvic
physiotherapist.