Korean J Urol KJU Korean Journal of Urology 0494-4747 The Korean Urological Association 10.4111/kju.2008.49.5.439 Original Article The Significance of the Parents' Description of Constipation in Pediatric Voiding Dysfunction Kim Ayoung 1 Lee Hyeyoung Hong Chang Hee Han Sang Won Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. Severance Children's Hospital, Yonsei University college of medicine, Seoul, Korea. swhan@yuhs.ac 05 2008 31 05 2008 49 5 439 442 04 03 2008 25 03 2008 Copyright © 2008 The Korean Urological Association 2008 Purpose

Dysfunctional voiding is closely related to constipation, and accurate evaluation of constipation is important. We investigated the accuracy and reliability of several methods that are used to evaluate constipation.

 Materials and Methods

We collected data from the parents of 168 dysfunctional voiders, and the data was collected using the Bristol stool form scale and the Leech method. We then analyzed the results of the questionnaire and compared them with the Paris Consensus on Childhood Constipation Terminology (PACCT).

 Results

Among the 168 dysfunctional voiders, 71 (42%) were diagnosed with constipation according to PACCT. Of the 39 children who were considered constipated, none were constipated according to PACCT. However, 35 of the 129 children whose parents denied they were constipation were in fact diagnosed with constipation. When the Leech method and the Bristol stool form scale were both used, the sensitivity of diagnosis rose to as high as 75%, and when the statement of the guardian was added, the sensitivity rose to as high as 85%.

 Conclusions

Since constipation can be a rather subjective condition, it would be appropriate to respect and incorporate the parents' statement into the diagnosis. However, for making a more accurate diagnosis, comprehensive evaluation based on specific symptoms and the Bristol stool form scale and the Leech method may be helpful.

 Constipation Urination disorders Chase JW Homsy Y Siggaard C Sit F Bower WF Functional constipation in children J Urol 2004 171 2641 2643 Neumann PZ DeDomenico IJ Nogrady MB Constipation and urinary tract infection Pediatrics 1973 52 241 245 Loening-Baucke V Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood Pediatrics 1997 100 228 232 Benninga M Candy DC Catto-Smith AG Clayden G Loening-Baucke V Di Lorenzo C The Paris consensus on childhood constipation terminology (PACCT) group J Pediatr Gastroenterol Nutr 2005 40 273 275 Riegler G Esposito I Bristol scale stool form. A still valid help in medical practice and clinical research Tech Coloproctol 2001 5 163 164 Leech SC McHugh K Sullivan PB Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children Pediatr Radiol 1999 29 255 258 van den Bosch M Graafmans D Nievelstein R Beek E Systematic assessment of constipation on plain abdominal radiographs in children Pediatr Radiol 2006 36 224 226 Kim HJ Lee JG The effect of distension of distal colon and rectum on micturition reflex in rats Korean J Urol 2001 42 1004 1007 Biggs WS Dery WH Evaluation and treatment of constipation in infants and children Am Fam Physician 2006 73 469 477 Dohil R Roberts E Jones KV Jenkins HR Constipation and reversible urinary tract abnormalities Arch Dis Child 1994 70 56 57 Loening-Baucke V Prevalence rates for constipation and faecal and urinary incontinence Arch Dis Child 2007 92 486 489 Loening-Baucke V Chronic constipation in children Gastroenterology 1993 105 1557 1564 Voskuijl WP Heijmans J Heijmans HS Taminiau JA Benninga MA Use of Rome II criteria in childhood defecation disorders: applicability in clinical and research practice J Pediatr 2004 145 213 217 Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition J Pediatr Gastroenterol Nutr 2006 43 e1 e13 Singh SJ Gibbons NJ Vincent MV Sithole J Nwokoma NJ Alagarswami KV Use of pelvic ultrasound in the diagnosis of megarectum in children with constipation J Pediatr Surg 2005 40 1941 1944 Bijos A Czerwionka-Szaflarska M Mazur A Romanczuk W The usefulness of ultrasound examination of the bowel as a method of assessment of functional chronic constipation in children Pediatr Radiol 2007 37 1247 1252 Klijn AJ Asselman M Vijverberg MA Dik P de Jong TP The diameter of the rectum on ultrasonography as a diagnostic tool for constipation in children with dysfunctional voiding J Urol 2004 172 1986 1988 O'Regan S Yazbeck S Hamberger B Schick E Constipation a commonly unrecognized cause of enuresis Am J Dis Child 1986 140 260 261 Akyol I Adayener C Senkul T Baykal K Iseri C An important issue in the management of elimination dysfunction in children: parental awareness of constipation Clin Pediatr (Phila) 2007 46 601 603

The sensitivity and specificity optimization by joint-diagnosis of the Leech method, the Bristol scale and the parents' statement. PACCT: Paris Consensus on Childhood Constipation Terminology.

The predictive values, sensitivity and specificity of several diagnostic methods