Internet Intervention for Childhood Encopresis
Internet Intervention for Childhood Encopresis
This study will evaluate the effectiveness of an Internet intervention designed to reduce the
 behaviors and symptoms of pediatric encopresis.
It is estimated that between 1.5% and 7.5% of children experience encopresis. In most
 children, encopresis is a complication of long-standing constipation. Encopresis is defined
 as the repeated passage of feces in inappropriate places at least once a month, for three
 months, and not induced through substances or due to a general medical condition. Typically,
 treatment consists of medical management alone, which focuses on diet and/or laxative therapy
 and has a relatively low success rate. A combination of specialized medical and behavioral
 interventions for encopresis (Enhanced Toilet Training) has been found to have high success
 rates. Unfortunately, it is not readily available because of a lack of trained professionals
 to deliver the treatment and the amount of time and costs spent in delivering this treatment.
 Internet interventions, however, may lower some of the barriers associated with traditional
 face-to-face treatments by removing the inconvenience of scheduling appointments, missing
 work/school, and traveling to and from a clinician's office. This study will evaluate whether
 an Internet intervention is more effective than patient education in treating pediatric
 encopresis. This study will also evaluate whether stepped care support is additive to the
 effectiveness of the Internet intervention. Stepped care will involve adding personal e-mail
 and phone support to help families overcome obstacles to using and implementing the
 intervention.

 Participants are randomized to receive a patient education website, the Internet intervention
 alone, or the Internet intervention plus stepped care. The intervention period lasts for 6
 weeks. During the intervention period, subjects assigned to the patient education website
 will be given content addressing treatment of encopresis. Those assigned to use the Internet
 intervention will review interactive tutorials tailored to the user's difficulties. The
 stepped care group will receive the Internet intervention as well as additional support if
 they fail to reach specific intervention milestones. All families will complete assessment
 questionnaires and daily diaries of the children's symptoms and bowel behaviors for one week
 at baseline, following the intervention period, and at 6 and 12 months follow-up.
Criteria for inclusion:

 A child and his or her parent/caregiver may participate in the study if:

 -  The parent/caregiver is the legal guardian of his or her child.

 -  The child is between the ages of 5 and 12.

 -  The child has had fecal accidents for at least the past three months.

 -  The child has had at least two fecal accidents during the past two weeks.

 -  The child and parent/caregiver have regular access to the Internet, either through the
 family computer or another readily accessible computer.

 Criteria for exclusion:

 A child and his or her parent/caregiver may not participate in the study if:

 -  The child has had an Endorectal Pull-Through Procedure.

 -  The child has a history of Short Bowel Syndrome.

 -  The child has a diagnosis of a primary illness responsible for fecal soiling (e.g.,
 Spinal Bifida, Hirschsprung's Disease).