Constipation/ encopheresis clinic

Chronic constipation is actually very common in children. Around 10% of kids will experience it at some point, and it's responsible for about 20% of referrals to a pediatric gastroenterologist. Constipation is basically when bowel movements become less frequent and more difficult. Constipation is defined as infrequent and difficult bowel movements.

Encopheresis (faeces leakage) occurs when faeces accumulate in the rectum and liquid parts leak into the underwear. It can be an accompanying symptom of chronic constipation in children, posing a challenge to treat and causing frustration for both the patient and their family.

Chronic constipation can occur when a child transitions from diapers, changes their diet, experiences illness, or goes on a long trip. The child's hesitation to use the bathroom leads to the formation of hard and painful stools, creating a cycle of avoidance, difficult elimination, and more avoidance. This can result in complications such as anal fissures, recurring urinary tract infections, excessive fecal buildup in the intestines, and involuntary leakage of feces (encopresis). 

These symptoms can lead to emotional difficulties and daily family stress. The quality of life for this group of children is lower compared to the general population. These children experience a decrease in overall functioning and more psychological issues than control populations. Furthermore, a quarter of the patients may continue to experience these symptoms into adulthood. Additionally, there is a correlation with later problems including depression, anxiety, and various physical complaints. 

The accepted treatment for constipation typically involves drug therapy using stool softeners, along with behavioral changes such as daily toilet sitting, and dietary modifications to include more fiber and fluids. It is important to continue the treatment over time, especially if the problem has persisted for a long duration prior to treatment. Even with treatment, the problem may persist for weeks or months, especially in children who come to treatment in late childhood or school age. Treatment failure, lack of response over time, and relapse after improvement are common occurrences.

Considering these challenges, we made the decision at the Pediatric Gastroenterology and Nutrition Unit, located at the Edmond and Lily Safra Children's Hospital, to integrate conventional treatments with complementary medicine approaches. Complementary medicine treatments, including mind-body techniques like guided imagery, hypnotherapy, self-hypnosis, and acupuncture, have shown effectiveness in treating chronic constipation in children.

For this purpose, a unique clinic was established, aiming to provide comprehensive diagnosis and treatment for constipation, encopresis, as well as recurring chronic abdominal pain. The clinic is staffed by a multidisciplinary team, including a pediatric gastroenterologist (Dr. Weiss) and a physician who manages the complementary medicine unit at Sheba Medical Center (Dr. Gamos). After an interview and examination of the child, the appropriate and desired treatment is determined. The complementary medicine techniques used in the clinic include hypnotherapy and self-hypnosis, Chinese medicine (acupuncture and herbs), as well as nutritional counseling.