The relationship between constipation and faecal and urinary retention is very familiar to paediatricians, but the prevalence of these distressing symptoms appears to vary in the medical literature. We will explore the background to the development of continence and how this may be disturbed by constipation.

REFLECTION ON THE ARTICLE

As Loening-Baucke stresses in the article, the problem with literature review has been the lack of an agreed set of definitions for constipation. The Paris consensus has improved on the Rome II definitions and she has shown how valuable it is to apply these even in a retrospective notes survey.¹ Her study also avoids the problem of extrapolating data from a referral centre to the whole community. As with any epidemiological study there may be characteristics of the community being studied that limit its generalisability. Loening-Baucke’s population is based on a university and so may not have an average socio-economic profile. A population based study in the UK showed a prevalence in 7.5 year old children of infrequent daytime faecal incontinence (no more than once a week) of 6.8% and of severe incontinence (at least daily) of 0.8%.²

IMPORTANCE OF CONTINENCE AND KNOWING ITS EPIDEMIOLOGY

The acquisition of continence is an essential element for children to be able to fully integrate with others and to access most public activities. Delays or disruptions in achieving continence will severely limit social life and continence is an important marker of quality of life at any age beyond toddlerhood. Unless we have a reasonable understanding of the prevalence of incontinence, it is impossible to focus resources on this important problem. However, a clear measure is extremely difficult. A degree of incontinence for one child or family may be so acceptable that it is never mentioned but for another may be the reason for …