A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

Abstract

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients SV Velde, SV Biervliet, RD Bruyne and MV Winckel Study design: Systematic review. Objectives: To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness. Setting: International literature. Method: Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion. Results: Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n ¼ 509). In patients using RCE (n ¼ 190) an 80% continence rate was reached. Patients following surgical treatment (n ¼ 469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management. Conclusion: Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.

Predictors of permanent disability among adults with spinal dysraphism

“…11 Continence rates with these methods range from 67-80%, and positively impact quality of life. 39 Anterograde colonic enema through a surgical ostomy may also be recommended for select individuals, with resultant continence rates exceeding 80% and reduced need for medication or rectal maneuvers. 15 Despite the availability of effective regimens, only 24% of our population reported having an active bowel regimen program.…”

Retrograde continence enema in children with spina bifida: Not as effective as first thought

“…According to a review by Velde et al ., pseudocontinence was achieved in 80% of patients using RCE . Although spina bifida was the underlying condition in the majority of patients pooled, miscellaneous conditions were considered.…”

Growing up with spina bifida: bridging the gaps in the transition of care from childhood to adulthood

“…Loss of intestinal peristalsis, rectal sensation, and anal sphincter function often result in a mixed clinical presentation of constipation and bowel incontinence. 52 As with urinary incontinence, loss of bowel control affects QOL, interfering with social relations and self-esteem. A study by Rocque et al 36 found that children older than 5 years with SB and bowel incontinence had a significantly decreased health-related QOL than those with bowel control.…”

“…12 However, this procedure should be reserved for patients in whom conservative medical management has failed, as it is associated with many complications, including stomal stenosis, stomal infection, and other stomal failures requiring revision. 44,52 Because a higher proportion of adult SB patients have undergone Malone creation, it is important for providers to recognize and treat these complications at an early stage to maintain continence.…”