Psychomotor approach in children affected by nonretentive fecal soiling (FNRFS): a new rehabilitative purpose

Maria Esposito,¹ Francesca Gimigliano,^1,2 Maria Ruberto,² Rosa Marotta,³ Beatrice Gallai,⁴ Lucia Parisi,⁵ Serena Marianna Lavano,³ Giovanni Mazzotta,⁶ Michele Roccella,⁵ Marco Carotenuto<sup>1

1</sup>Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy; ²Department of Odontostomathologic Disciplines, Head Pathology, Orthopedic Sciences, Second University of Naples, Italy; ³Department of Psychiatry, Magna Graecia University of Catanzaro, Catanzaro, Italy; ⁴Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy; ⁵Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy; ⁶Unit of Child and Adolescent Neuropsychiatry, AUSL Umbria, Terni, Italy

Background: According to the Rome III criteria, encopresis without constipation was defined as nonretentive fecal soiling (FNRFS) with not yet well understood etiology. Treatment approaches reported in the literature with varying results include biofeedback, hypnosis, reflexology, and Internet-based educational programs. In developmental age, another behavioral treatment could be identified in the psychomotor approach, which is called psychomotricity in the European countries, or is also known as play therapy. The aim of the present study was to verify the safety and efficacy of play therapy plus toilet training in a small sample of prepubertal children affected by FNRFS.
Materials and methods: Twenty-six patients (group 1; 16 males, mean age of 5.92 ± 0.84 years) underwent a psychomotor approach therapy program in association with toilet training for 6 months, and the other 26 subjects (group 2; 17 males, mean age of 5.76 ± 0.69) underwent the sole toilet training program for 6 months. During the observational time period (T0) and after 6 months (T1) of both treatments, the patients were evaluated for FNRFS frequency and for the behavioral assessment.
Results: At T0, the FNRFS mean frequency per month for group 1 was 20.115 episodes/month (standard deviation [SD] ± 3.024) and for group 2 was 20.423 (SD ± 1.879) (P = 0.661). At T1 the mean frequency per month was 6.461 (SD ± 1.333) episodes/month and 12.038 (SD ± 1.341), respectively (P < 0.001). Moreover, the delta percent average of the frequency between T0 and T1 was 67.121 ± 8.527 for group 1 and 40.518 ± 9.259 for group 2 (P < 0.001). At T1, a significant improvement in scores on the behavioral scale was identified.
Conclusion: Our preliminary results show the importance of a multidisciplinary approach, and suggest the positive effect of an additional psychomotor approach, as this holds a new and interesting rehabilitative purpose for children in a toilet training program, even if further research is necessary.

Keyword: encopresis, psychomotricity, children, toilet training, rehabilitation