Empirically Supported Treatments in Pediatric Psychology: Constipation and Encopresis

The purpose of this article was to review the empirical research examining behavioral and medical treatments for constipation and fecal incontinence. Forty-two controlled outcome studies investigating intervention efficacy were included. The intervention protocol for each study was identified and coded. Studies employing the same interventions were matched and evaluated by use of the Chambless criteria, a set of criteria proposed to evaluate the adequacy of empirical evidence for individual intervention strategies. None of the treatments investigated met the criteria for the highest level of empirical support. Four intervention protocols, however, were deemed "probably efficacious" and 3 protocols were labeled "promising." The authors conclude that the addition of biofeedback and/or behavioral intervention (e.g., positive reinforcement for appropriate bowel movements) increases the the efficacy of a standard medical treatment. In particular, when children evidence constipation and abnormal defecation dynamics, biofeedback appears to increase efficacy. In children diagnosed with encopresis or with constipation and incontinence (defecation dynamics not assessed), behavioral intervention appears to increase efficacy. Medical interventions were found to be a part of almost all interventions in the literature, and initial bowel cleanout and laxative therapy appeared to be the most efficacious medical treatment components. The authors discuss current weaknesses in this research area and offer specific recommendations for future research.