Stephen Borowitz | University of Virginia (original) (raw)

Papers by Stephen Borowitz

Professional Psychology: Research and Practice, 2003

The provision of health care over the Internet is a rapidly evolving and potentially beneficial m... more The provision of health care over the Internet is a rapidly evolving and potentially beneficial means of delivering treatment otherwise unsought or unobtainable. Internet interventions are typically behavioral treatments operationalized and transformed for Web delivery with the goal of symptom improvement. The literature on the feasibility and utility of Internet interventions is limited, and there are even fewer outcome study findings. This article reviews empirically tested Internet interventions and provides an overview of the issues in developing and/or using them in clinical practice. Future directions and implications are also addressed. Although Internet interventions will not likely replace face-to-face care, there is little doubt that they will grow in importance as a powerful component of successful psychobehavioral treatment. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Lee M.

Clinical Pediatrics, 1995

We describe the long-term (mean 6.8 years) follow-up of 43 children treated medically for chronic... more We describe the long-term (mean 6.8 years) follow-up of 43 children treated medically for chronic constipation and encopresis. Overall outcome was quite good. Thirty children (70%) were entirely asymptomatic at follow-up. Intermittent mild constipation persisted in 13 patients; only two required persistent but infrequent laxative therapy. Encopresis persisted in three of 17 children who initially reported this symptom, and was associated with significant behavioral problems.

Diseases of The Colon & Rectum, 1996

Chronic constipation is an extremely common problem in children. Many authors have advocated usin... more Chronic constipation is an extremely common problem in children. Many authors have advocated using anorectal manometric examination during evaluation of chronic childhood constipation and encopresis as a means of developing individualized modes of treatment. PURPOSE: This study was designed to prospectively examine frequency and severity of symptoms of childhood constipation and encopresis and associate these symptoms with anorectal manometric findings. METHODS: Forty-four children with chronic constipation participated in the study. Before performing anorectal manometry, bowel-related symptoms were collected for two consecutive weeks with a computerized voice mail system. Anorectal manometry was performed using a triple lumen catheter attached to a hydraulic manometry infusion system. RESULTS: Frequency of voluntary bowel movements did not correlate with any manometric parameters. Frequency of fecal soiling, age at onset of symptoms, and duration of symptoms were all highly correlated with degree of sphincter spasm during attempted defecation; however, none of these variables correlated with any other manometric parameter. Amount of pain associated with bowel movements correlated with frequency of soiling and was inversely correlated with maximum squeeze pressure but was not correlated with any other manometric parameter. CONCLUSIONS: In children with chronic constipation and encopresis, sphincter spasm demonstrated with anorectal manometry is highly correlated with frequency of fecal soiling, age at onset, and duration of symptoms; however, none of the other commonly measured manometric parameters appear to correlate with symptoms of chronic childhood constipation and encopresis.

Journal of Pediatric Psychology, 2002

To validate a theoretical model of encopresis in terms of psychological factors that differentiat... more To validate a theoretical model of encopresis in terms of psychological factors that differentiates children with and without chronic encopresis and to identify scales that demonstrate these differences.

Professional Psychology-research and Practice, 2003

The provision of health care over the Internet is a rapidly evolving and potentially beneficial m... more The provision of health care over the Internet is a rapidly evolving and potentially beneficial means of delivering treatment otherwise unsought or unobtainable. Internet interventions are typically behavioral treatments operationalized and transformed for Web delivery with the goal of symptom improvement. The literature on the feasibility and utility of Internet interventions is limited, and there are even fewer outcome study findings. This article reviews empirically tested Internet interventions and provides an overview of the issues in developing and/or using them in clinical practice. Future directions and implications are also addressed. Although Internet interventions will not likely replace face-to-face care, there is little doubt that they will grow in importance as a powerful component of successful psychobehavioral treatment. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Lee M.

Background: Childhood constipation is a common problem, accounting for 3% of visits to pediatric ... more Background: Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and 30% of visits to pediatric gastroenterologists. Estimates of the prevalence of childhood constipation vary from 0.3% to 28% with younger children being affected most often. We were unable to find any studies that specifically examine the causes of constipation in young children. Our objective of the study was to determine precipitants to constipation during early childhood.

Journal of Medical Internet Research, 2008

The Internet is a significant source of medical information and is now being shown to be an impor... more The Internet is a significant source of medical information and is now being shown to be an important conduit for delivering various health-related interventions. This paper aimed to examine the utility and impact of an Internet intervention for childhood encopresis as part of standard medical care in a "real world" setting. Patients diagnosed with encopresis were given a Web-based information prescription to use an Internet intervention for pediatric encopresis. A total of 22 families utilized the intervention between July 2004 and June 2006. A chart review and phone interview were undertaken to collect user characteristics; defecation-related information, including frequency of soiling, bowel movements (BMs) in the toilet, and amount of pain associated with defecation; and information on computer/Internet usage. Three questionnaires were used to examine the utility of, impact of, and adherence to the Internet intervention. Program utilization was obtained from a data tracking system that monitored usage in real time. Overall, parents rated the Internet intervention as enjoyable, understandable, and easy to use. They indicated that the Internet intervention positively affected their children, decreasing overall accidents and increasing child comfort on the toilet at home. Of the 20 children who initially reported fecal accidents, 19 (95%) experienced at least a 50% improvement, with a reduction of accident frequency from one fecal accident per day to one accident per week. Although it is not clear whether this improvement is directly related to the use of the Internet intervention, patient feedback suggests that the program was an important element, further establishing Internet interventions as a viable and desirable addition to standard medical care for pediatric encopresis. To our knowledge, this is the first time a pediatric Internet intervention has been examined as part of a "real world" setting. This is an important step toward establishing Internet interventions as an adjunctive component to treatment of pediatric patients in a clinical setting, particularly given the positive user feedback, possible cost savings, and significant potential for large-scale dissemination.

Journal of Pediatric Gastroenterology and Nutrition, 2004

Inflammatory bowel disease (IBD) is characterized by periods of relapse and remission. Treatment ... more Inflammatory bowel disease (IBD) is characterized by periods of relapse and remission. Treatment is aimed at reducing symptoms during relapse and prolonging the duration of remissions. 6-Mercaptopurine (6-MP) and its prodrug azathioprine (AZA) are commonly used to prolong clinical remissions. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two widely used laboratory markers of inflammation. The authors observed an unexplained discordance between ESR and CRP in children with asymptomatic IBD who were being treated with AZA or 6-MP. To characterize children with IBD in remission treated with 6-MP or AZA who have persistently elevated ESR but normal CRP. All patients seen in Pediatric Gastroenterology Clinic between January 1, 1995, and December 31, 2002, with Crohn disease or ulcerative colitis who received AZA or 6-MP continuously for at least 6 months were identified and their medical records reviewed. One hundred twenty patients met the eligibility criteria. Twelve had an ESR >18 mm/hour on at least three occasions during at least 12 consecutive months with a simultaneous CRP <0.8 mg/dL. Eleven of these 12 had no signs or symptoms of active disease and had Pediatric Crohn Disease Activity Index scores <10 for at least 12 consecutive months while the ESR was elevated. Disease duration was similar in the 11 children with asymptomatic disease and with discordant ESR and CRP and in 108 children with concordant ESR and CRP (69.2 + 22.5 months v 54.3 +/- 40.1 months, P = 0.0709). Duration of AZA or 6-MP therapy was greater in the 11 children with asymptomatic disease and discordant ESR and CRP than in those with or without symptoms and with concordant ESR and CRP (58.1 +/- 16.4 months v 36.6 +/- 24.1 months, P = 0.0043). There were no differences between the groups with respect to diagnosis, location of disease, or age at onset of symptoms. The mean corpuscular volume (MCV) was somewhat larger in the children with discordant ESR and CRP than in the children with concordant ESR and CRP (91.4 +/- 6.97 fL v 87.0 +/-7.07 fL, respectively, P = 0.0373); however, in both groups, the MCV was in the normal range. There were no significant differences in hematocrit, white blood cell count, serum albumin, total serum protein, or estimated serum globulin between the groups. The results suggest that among children treated with AZA or 6-MP, CRP may be a more reliable indirect indicator of inflammation than ESR. This report alerts clinicians that some children taking AZA or 6-MP may have persistent elevation of the ESR with a normal CRP and have no clinical evidence of active disease.

Journal of Developmental and Behavioral Pediatrics, 2000

No studies have compared toileting-specific behaviors of encopretic children with those of asympt... more No studies have compared toileting-specific behaviors of encopretic children with those of asymptomatic children and have controlled for environmental factors such as parental attitudes, parenting styles, and bathroom facilities. This study prospectively examined the toileting habits of 86 chronically encopretic children compared with those of 27 asymptomatic siblings and 35 asymptomatic nonsiblings. Although encopretic children experienced significantly more soiling than did controls, the total number of daily bowel movements passed in the toilet (+/-SD) was comparable in the three groups (.92 +/- .76 in encopretic children compared with 1.14 +/- .43 and 1.08 +/- .47 in siblings and nonsiblings, respectively). Encopretic children experienced pain with defecation more often than did controls. During the 14-day study period, encopretic children complained of pain on 2.75 +/- 4.03 days compared with .58 +/- 1.84 days among sibling controls and 2.31 +/- 3.21 days among nonsibling controls. The mean pain score in encopretic children was .76 +/- 1.00 compared with .05 +/- .15 and .26 +/- .38 among siblings and nonsiblings, respectively. All three groups of children sat on the toilet without parental prompting the same number of times each day. In summary, children with chronic encopresis do not seem to avoid toileting, and they exhibit toileting behaviors that are very similar to those of asymptomatic siblings as well as to those of nonsibling controls.

Professional Psychology-research and Practice, 2001

... STEPHEN M. BOROWITZ received his MD from Rush Medical College in Chicago in 1980 ... WILLIAM ... more ... STEPHEN M. BOROWITZ received his MD from Rush Medical College in Chicago in 1980 ... WILLIAM D. LING received his PhD from the University of Virginia in 1993, with ... whereas comparisons of gender between groups were performed using a Kruskal-Wallis nonparametric ...

Diseases of The Colon & Rectum, 1997

PURPOSE: We have investigated the use of anorectal manometry to distinguish encopretic-constipate... more PURPOSE: We have investigated the use of anorectal manometry to distinguish encopretic-constipated children (n=88) from sibling controls (n=16) and nonsibling controls (n=11). METHODS: Study variables included manometrically determined resting and maximum voluntary anal sphincter pressure, depth and speed of rectoanal inhibitory reflex, minimum rectal volume sensation, critical distending volume for fecal urgency, rectal and anal pressure responses during attempted defecation, and ability to defecate a water-filled balloon. RESULTS: Change in anal sphincter pressure during attempted defecation (P=0.03), gradient between rectal and sphincter pressure during attempted defecation (P=0.02), critical distending volume for fecal urgency (P=0.02), and ability to defecate a water-filled balloon (P=0.05) distinguished encopretic-constipated from control children. The change in rectal pressure associated with the rectoanal inhibitory reflex just escaped significance at P=0.07. CONCLUSIONS: Anal sphincter spasm and megacolon are pathophysiologic abnormalities associated with pediatric constipation-encopresis.

Journal of Pediatric Psychology, 2003

ensue, allowing fecal matter above the impaction to leak around and out (overflow incontinence). ... more ensue, allowing fecal matter above the impaction to leak around and out (overflow incontinence). (H) Parents may respond by requesting their child use the toilet more often, which the child may resist. (I) This resistance and continued fecal soiling can set the stage for parent-child conflict over toileting. ( J) Persistent soiling can then lead the child to experience shame and rejection and engage in deception such as hiding or lying about dirty underwear.

Journal of Consulting and Clinical Psychology, 2003

Children's Health Care, 2006

... health and health care, few interventions have been systematically evaluated, and most are in... more ... health and health care, few interventions have been systematically evaluated, and most are intended for adults (see reviews by Ritterband, Gonder-Frederick, et al., 2003; Wantland, Portillo, Holzemer, Slaughter, McGhee, 2004 ... OPTIMIZING THE “U-CAN-POOP-TOO” PROGRAM ...

Applied Psychophysiology and Biofeedback, 1994

Pediatric constipation/encopresis is thought to be due, in part, to paradoxical constriction of t... more Pediatric constipation/encopresis is thought to be due, in part, to paradoxical constriction of the external anal sphincter (EAS) muscle during attempted defecation. This inappropriate contraction can lead to delayed, impacted, painful, and infrequent bowel movements. Standard Medical Care (SMC) involves disimpaction with enemas, followed by laxative therapy and diet modification, to maintain frequent soft stools. Using the case control method, the efficacy of SMC alone was compared with SMC plus EAS electromyographic biofeedback aimed at eliminating paradoxical contraction. Thirteen consecutive chronically constipated children received SMC plus biofeedback, and were compared with 13 age- and sex-matched children who received only SMC. Biofeedback subjects demonstrated post-treatment elimination of EAS paradoxical constriction. At 16 months follow-up parents of biofeedback children reported significantly greater improvement in constipation, encopresis, laxative use, and painful bowel movements compared to SMC.

Introduction. An information prescription is the provision of specific information to a patient o... more Introduction. An information prescription is the provision of specific information to a patient on how to help manage a health problem. The Internet is being used increasingly as a source for information prescriptions, with clinicians directing patients to specific Web sites. As with any health care intervention, patients' lack of compliance is a barrier to the effectiveness of Web-based information prescriptions (WebIPs). WebIPs cannot be helpful if patients do not review the information prescribed for them.

Annals of Behavioral Medicine, 2000

This review summarizes the literature on randomized, controlled, published studies involving medi... more This review summarizes the literature on randomized, controlled, published studies involving medical, behavioral, psychological, and biofeedback treatments for encopresis/functional constipation and stool-toileting refusal in preschool-age and school-age children. Nine such studies were located in the literature involving school-age children. No randomized, controlled treatment studies involving preschool-age children have been published. This review revealed no evidence to support the routine use of psychotherapy or anal sphincter biofeedback in the treatment of pediatric fecal elimination dysfunctions, beyond those benefits derived from a comprehensive medical-behavioral intervention. Further, this review indicated that paradoxical constriction of the External Anal Sphincter does not influence the treatment outcome of either biofeedback or medical-behavioral interventions. There are remarkably few controlled treatment outcome studies in this most important clinical area. More research is needed that employs standard treatment outcome variables.

Professional Psychology: Research and Practice, 2003

The provision of health care over the Internet is a rapidly evolving and potentially beneficial m... more The provision of health care over the Internet is a rapidly evolving and potentially beneficial means of delivering treatment otherwise unsought or unobtainable. Internet interventions are typically behavioral treatments operationalized and transformed for Web delivery with the goal of symptom improvement. The literature on the feasibility and utility of Internet interventions is limited, and there are even fewer outcome study findings. This article reviews empirically tested Internet interventions and provides an overview of the issues in developing and/or using them in clinical practice. Future directions and implications are also addressed. Although Internet interventions will not likely replace face-to-face care, there is little doubt that they will grow in importance as a powerful component of successful psychobehavioral treatment. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Lee M.

Clinical Pediatrics, 1995

We describe the long-term (mean 6.8 years) follow-up of 43 children treated medically for chronic... more We describe the long-term (mean 6.8 years) follow-up of 43 children treated medically for chronic constipation and encopresis. Overall outcome was quite good. Thirty children (70%) were entirely asymptomatic at follow-up. Intermittent mild constipation persisted in 13 patients; only two required persistent but infrequent laxative therapy. Encopresis persisted in three of 17 children who initially reported this symptom, and was associated with significant behavioral problems.

Diseases of The Colon & Rectum, 1996

Chronic constipation is an extremely common problem in children. Many authors have advocated usin... more Chronic constipation is an extremely common problem in children. Many authors have advocated using anorectal manometric examination during evaluation of chronic childhood constipation and encopresis as a means of developing individualized modes of treatment. PURPOSE: This study was designed to prospectively examine frequency and severity of symptoms of childhood constipation and encopresis and associate these symptoms with anorectal manometric findings. METHODS: Forty-four children with chronic constipation participated in the study. Before performing anorectal manometry, bowel-related symptoms were collected for two consecutive weeks with a computerized voice mail system. Anorectal manometry was performed using a triple lumen catheter attached to a hydraulic manometry infusion system. RESULTS: Frequency of voluntary bowel movements did not correlate with any manometric parameters. Frequency of fecal soiling, age at onset of symptoms, and duration of symptoms were all highly correlated with degree of sphincter spasm during attempted defecation; however, none of these variables correlated with any other manometric parameter. Amount of pain associated with bowel movements correlated with frequency of soiling and was inversely correlated with maximum squeeze pressure but was not correlated with any other manometric parameter. CONCLUSIONS: In children with chronic constipation and encopresis, sphincter spasm demonstrated with anorectal manometry is highly correlated with frequency of fecal soiling, age at onset, and duration of symptoms; however, none of the other commonly measured manometric parameters appear to correlate with symptoms of chronic childhood constipation and encopresis.

Journal of Pediatric Psychology, 2002

To validate a theoretical model of encopresis in terms of psychological factors that differentiat... more To validate a theoretical model of encopresis in terms of psychological factors that differentiates children with and without chronic encopresis and to identify scales that demonstrate these differences.

Professional Psychology-research and Practice, 2003

The provision of health care over the Internet is a rapidly evolving and potentially beneficial m... more The provision of health care over the Internet is a rapidly evolving and potentially beneficial means of delivering treatment otherwise unsought or unobtainable. Internet interventions are typically behavioral treatments operationalized and transformed for Web delivery with the goal of symptom improvement. The literature on the feasibility and utility of Internet interventions is limited, and there are even fewer outcome study findings. This article reviews empirically tested Internet interventions and provides an overview of the issues in developing and/or using them in clinical practice. Future directions and implications are also addressed. Although Internet interventions will not likely replace face-to-face care, there is little doubt that they will grow in importance as a powerful component of successful psychobehavioral treatment. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Lee M.

Background: Childhood constipation is a common problem, accounting for 3% of visits to pediatric ... more Background: Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and 30% of visits to pediatric gastroenterologists. Estimates of the prevalence of childhood constipation vary from 0.3% to 28% with younger children being affected most often. We were unable to find any studies that specifically examine the causes of constipation in young children. Our objective of the study was to determine precipitants to constipation during early childhood.

Journal of Medical Internet Research, 2008

The Internet is a significant source of medical information and is now being shown to be an impor... more The Internet is a significant source of medical information and is now being shown to be an important conduit for delivering various health-related interventions. This paper aimed to examine the utility and impact of an Internet intervention for childhood encopresis as part of standard medical care in a "real world" setting. Patients diagnosed with encopresis were given a Web-based information prescription to use an Internet intervention for pediatric encopresis. A total of 22 families utilized the intervention between July 2004 and June 2006. A chart review and phone interview were undertaken to collect user characteristics; defecation-related information, including frequency of soiling, bowel movements (BMs) in the toilet, and amount of pain associated with defecation; and information on computer/Internet usage. Three questionnaires were used to examine the utility of, impact of, and adherence to the Internet intervention. Program utilization was obtained from a data tracking system that monitored usage in real time. Overall, parents rated the Internet intervention as enjoyable, understandable, and easy to use. They indicated that the Internet intervention positively affected their children, decreasing overall accidents and increasing child comfort on the toilet at home. Of the 20 children who initially reported fecal accidents, 19 (95%) experienced at least a 50% improvement, with a reduction of accident frequency from one fecal accident per day to one accident per week. Although it is not clear whether this improvement is directly related to the use of the Internet intervention, patient feedback suggests that the program was an important element, further establishing Internet interventions as a viable and desirable addition to standard medical care for pediatric encopresis. To our knowledge, this is the first time a pediatric Internet intervention has been examined as part of a "real world" setting. This is an important step toward establishing Internet interventions as an adjunctive component to treatment of pediatric patients in a clinical setting, particularly given the positive user feedback, possible cost savings, and significant potential for large-scale dissemination.

Journal of Pediatric Gastroenterology and Nutrition, 2004

Inflammatory bowel disease (IBD) is characterized by periods of relapse and remission. Treatment ... more Inflammatory bowel disease (IBD) is characterized by periods of relapse and remission. Treatment is aimed at reducing symptoms during relapse and prolonging the duration of remissions. 6-Mercaptopurine (6-MP) and its prodrug azathioprine (AZA) are commonly used to prolong clinical remissions. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two widely used laboratory markers of inflammation. The authors observed an unexplained discordance between ESR and CRP in children with asymptomatic IBD who were being treated with AZA or 6-MP. To characterize children with IBD in remission treated with 6-MP or AZA who have persistently elevated ESR but normal CRP. All patients seen in Pediatric Gastroenterology Clinic between January 1, 1995, and December 31, 2002, with Crohn disease or ulcerative colitis who received AZA or 6-MP continuously for at least 6 months were identified and their medical records reviewed. One hundred twenty patients met the eligibility criteria. Twelve had an ESR >18 mm/hour on at least three occasions during at least 12 consecutive months with a simultaneous CRP <0.8 mg/dL. Eleven of these 12 had no signs or symptoms of active disease and had Pediatric Crohn Disease Activity Index scores <10 for at least 12 consecutive months while the ESR was elevated. Disease duration was similar in the 11 children with asymptomatic disease and with discordant ESR and CRP and in 108 children with concordant ESR and CRP (69.2 + 22.5 months v 54.3 +/- 40.1 months, P = 0.0709). Duration of AZA or 6-MP therapy was greater in the 11 children with asymptomatic disease and discordant ESR and CRP than in those with or without symptoms and with concordant ESR and CRP (58.1 +/- 16.4 months v 36.6 +/- 24.1 months, P = 0.0043). There were no differences between the groups with respect to diagnosis, location of disease, or age at onset of symptoms. The mean corpuscular volume (MCV) was somewhat larger in the children with discordant ESR and CRP than in the children with concordant ESR and CRP (91.4 +/- 6.97 fL v 87.0 +/-7.07 fL, respectively, P = 0.0373); however, in both groups, the MCV was in the normal range. There were no significant differences in hematocrit, white blood cell count, serum albumin, total serum protein, or estimated serum globulin between the groups. The results suggest that among children treated with AZA or 6-MP, CRP may be a more reliable indirect indicator of inflammation than ESR. This report alerts clinicians that some children taking AZA or 6-MP may have persistent elevation of the ESR with a normal CRP and have no clinical evidence of active disease.

Journal of Developmental and Behavioral Pediatrics, 2000

No studies have compared toileting-specific behaviors of encopretic children with those of asympt... more No studies have compared toileting-specific behaviors of encopretic children with those of asymptomatic children and have controlled for environmental factors such as parental attitudes, parenting styles, and bathroom facilities. This study prospectively examined the toileting habits of 86 chronically encopretic children compared with those of 27 asymptomatic siblings and 35 asymptomatic nonsiblings. Although encopretic children experienced significantly more soiling than did controls, the total number of daily bowel movements passed in the toilet (+/-SD) was comparable in the three groups (.92 +/- .76 in encopretic children compared with 1.14 +/- .43 and 1.08 +/- .47 in siblings and nonsiblings, respectively). Encopretic children experienced pain with defecation more often than did controls. During the 14-day study period, encopretic children complained of pain on 2.75 +/- 4.03 days compared with .58 +/- 1.84 days among sibling controls and 2.31 +/- 3.21 days among nonsibling controls. The mean pain score in encopretic children was .76 +/- 1.00 compared with .05 +/- .15 and .26 +/- .38 among siblings and nonsiblings, respectively. All three groups of children sat on the toilet without parental prompting the same number of times each day. In summary, children with chronic encopresis do not seem to avoid toileting, and they exhibit toileting behaviors that are very similar to those of asymptomatic siblings as well as to those of nonsibling controls.

Professional Psychology-research and Practice, 2001

... STEPHEN M. BOROWITZ received his MD from Rush Medical College in Chicago in 1980 ... WILLIAM ... more ... STEPHEN M. BOROWITZ received his MD from Rush Medical College in Chicago in 1980 ... WILLIAM D. LING received his PhD from the University of Virginia in 1993, with ... whereas comparisons of gender between groups were performed using a Kruskal-Wallis nonparametric ...

Diseases of The Colon & Rectum, 1997

PURPOSE: We have investigated the use of anorectal manometry to distinguish encopretic-constipate... more PURPOSE: We have investigated the use of anorectal manometry to distinguish encopretic-constipated children (n=88) from sibling controls (n=16) and nonsibling controls (n=11). METHODS: Study variables included manometrically determined resting and maximum voluntary anal sphincter pressure, depth and speed of rectoanal inhibitory reflex, minimum rectal volume sensation, critical distending volume for fecal urgency, rectal and anal pressure responses during attempted defecation, and ability to defecate a water-filled balloon. RESULTS: Change in anal sphincter pressure during attempted defecation (P=0.03), gradient between rectal and sphincter pressure during attempted defecation (P=0.02), critical distending volume for fecal urgency (P=0.02), and ability to defecate a water-filled balloon (P=0.05) distinguished encopretic-constipated from control children. The change in rectal pressure associated with the rectoanal inhibitory reflex just escaped significance at P=0.07. CONCLUSIONS: Anal sphincter spasm and megacolon are pathophysiologic abnormalities associated with pediatric constipation-encopresis.

Journal of Pediatric Psychology, 2003

ensue, allowing fecal matter above the impaction to leak around and out (overflow incontinence). ... more ensue, allowing fecal matter above the impaction to leak around and out (overflow incontinence). (H) Parents may respond by requesting their child use the toilet more often, which the child may resist. (I) This resistance and continued fecal soiling can set the stage for parent-child conflict over toileting. ( J) Persistent soiling can then lead the child to experience shame and rejection and engage in deception such as hiding or lying about dirty underwear.

Journal of Consulting and Clinical Psychology, 2003

Children's Health Care, 2006

... health and health care, few interventions have been systematically evaluated, and most are in... more ... health and health care, few interventions have been systematically evaluated, and most are intended for adults (see reviews by Ritterband, Gonder-Frederick, et al., 2003; Wantland, Portillo, Holzemer, Slaughter, McGhee, 2004 ... OPTIMIZING THE “U-CAN-POOP-TOO” PROGRAM ...

Applied Psychophysiology and Biofeedback, 1994

Pediatric constipation/encopresis is thought to be due, in part, to paradoxical constriction of t... more Pediatric constipation/encopresis is thought to be due, in part, to paradoxical constriction of the external anal sphincter (EAS) muscle during attempted defecation. This inappropriate contraction can lead to delayed, impacted, painful, and infrequent bowel movements. Standard Medical Care (SMC) involves disimpaction with enemas, followed by laxative therapy and diet modification, to maintain frequent soft stools. Using the case control method, the efficacy of SMC alone was compared with SMC plus EAS electromyographic biofeedback aimed at eliminating paradoxical contraction. Thirteen consecutive chronically constipated children received SMC plus biofeedback, and were compared with 13 age- and sex-matched children who received only SMC. Biofeedback subjects demonstrated post-treatment elimination of EAS paradoxical constriction. At 16 months follow-up parents of biofeedback children reported significantly greater improvement in constipation, encopresis, laxative use, and painful bowel movements compared to SMC.

Introduction. An information prescription is the provision of specific information to a patient o... more Introduction. An information prescription is the provision of specific information to a patient on how to help manage a health problem. The Internet is being used increasingly as a source for information prescriptions, with clinicians directing patients to specific Web sites. As with any health care intervention, patients' lack of compliance is a barrier to the effectiveness of Web-based information prescriptions (WebIPs). WebIPs cannot be helpful if patients do not review the information prescribed for them.

Annals of Behavioral Medicine, 2000

This review summarizes the literature on randomized, controlled, published studies involving medi... more This review summarizes the literature on randomized, controlled, published studies involving medical, behavioral, psychological, and biofeedback treatments for encopresis/functional constipation and stool-toileting refusal in preschool-age and school-age children. Nine such studies were located in the literature involving school-age children. No randomized, controlled treatment studies involving preschool-age children have been published. This review revealed no evidence to support the routine use of psychotherapy or anal sphincter biofeedback in the treatment of pediatric fecal elimination dysfunctions, beyond those benefits derived from a comprehensive medical-behavioral intervention. Further, this review indicated that paradoxical constriction of the External Anal Sphincter does not influence the treatment outcome of either biofeedback or medical-behavioral interventions. There are remarkably few controlled treatment outcome studies in this most important clinical area. More research is needed that employs standard treatment outcome variables.