Potty stool helps kids with functional constipation wean off medication

A defecation posture modification device (DPMD), also known as a potty stool, is both safe and beneficial for children with functional constipation (FC), helping them wean off pharmacotherapy and improving their bowel function, according to a study presented at the recently concluded 2022 Digestive Disease Week (DDW 2022).

“FC comprises 30 percent of paediatric gastroenterology clinic visits,” the researchers said. “FC results from withholding behaviours that can potentially be worsened by poor toileting posture.”

Since the use of DPMDs has yielded notable benefits for adult FC patients, the present study sought to evaluate its efficacy and potential risks in young patients.

Forty-three toilet-trained paediatric patients (aged ≥4 years) participated in this open-label pilot study, all of whom met the ROME IV criteria for FC. Participants were categorized as regular users (n=25, mean age 12.5 years, 32 percent boys) if they reported using the potty stool “almost always” or “often” during defecating; those who did not, on the other hand, were classified as nonusers (n=18, mean age 10.8 years, 44 percent boys).

Weaning off of pharmacotherapy was significantly more successful among DPMD users vs nonusers who achieved Paediatric Bristol Stool Form Scale (PBSFS) scores 3 or 4 by the end of the study (57 percent vs 31 percent; p=0.02), suggesting that the potty stool helps improve bowel movement in this population. [DDW 2022, abstract Mo1668]

The use of DPMD also proved to be highly safe, with no reported injuries or treatment-related adverse events. As a result, 98 percent of participants said that they would recommend the device to other children suffering from FC.

Moreover, participants felt that the potty stool was an effective treatment for FC because it was natural (56 percent), portable (30 percent), easy to use (70 percent), and/or safe (30 percent).

Nevertheless, clinical outcomes, as measured by the ROME IV Paediatric Diagnostic Questionnaire and the PBSFS, did not significantly differ between groups. For instance, FC resolution was reported in 80 percent of users and 83 percent of nonusers (p=0.78). Meanwhile, a PBSFS score 3 or 4 was achieved by 84 percent and 72 percent of participants in the respective groups (p=0.35).

Reduction in faecal incontinence was likewise not significantly affected by the use of DPMD, with rates of 33 percent and 60 percent in users and nonusers, respectively (p=0.61).

In turn, quantitative assessments of health-related quality of life likewise revealed no significant between-group differences, with a mean Total Scale Score (TSS) of 68.0 in users and 68.4 in nonusers. Mean TSS improvements from baseline were likewise comparable (4.0 vs 8.9; p=0.23).

The present study adds to a growing literature regarding the benefits of DPMDs in patients with FC, though most studies have focused on its use in adult patients. If validated by future studies, with larger sample sizes and showing significant clinical benefit, potty stools may be a nonpharmacological therapeutic alternative for children with FC.