Bowel and Bladder Control of Children With Myelomeningocele: A Nordic Study

Lie, H. R.; Lagergren, J; Rasmussen, Finn; Lagerkvist, Bengt; J, Hagelsteen; Börjeson, Mats; Muttilainen, M.; Taudorf, K

doi:10.1111/j.1469-8749.1991.tb14827.x

Cited by 86 publications

(34 citation statements)

References 23 publications

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“…3,4,6,[17][18][19][20][21][22] Clinical efficacy was based on parameters such as fecal continence/pseudo-continence, frequency of bowel movements, bowel care time (in minutes per day) and the number of diaper changes per day. Fecal continence was defined as no involuntary stool loss in the treatment with TAI alone, and pseudo-continence was defined as involuntary stool loss no more than once a week with the use of TAI treatment.…”

Section: Instrumentsmentioning

confidence: 99%

Long-term outcome of transanal irrigation for children with spina bifida

et al. 2014

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Study design: Experimental, prospective study. Objectives: We evaluated the long-term clinical efficacy of transanal irrigation (TAI) and its effect on the quality of life of spina bifida children and their caregivers. Setting: Republic of Korea. Method: Forty-four spina bifida pediatric patients with constipation, fecal incontinence or both, underwent a TAI program at our spina bifida clinic between December 2010 and October 2013. The children and their caregivers were evaluated using a self-administered questionnaire before TAI and at 3 months and 3 years after initiation of the program. Results: Successful treatment outcome was achieved in 38 (86.4%) children after a mean follow-up duration of 33 months (range, 30-36). The mean number of fecal incontinence episodes per week, the number of diaper changes and the total time for bowel care per day before the program decreased at the latest follow-up examination from 7.3 to 0.4 (Po0.001), 1.6 to 0.2 (Po0.001) and 29.2 to 19.4 min (P = 0.038), respectively. These results remained constant from short-term follow-up at 3 months to 3 years. Caregivers and children could go out more often (P = 0.002), and the emotional impact of bowel care on caregivers decreased (Po0.001). The reported mean overall satisfaction with TAI was 8/10. The common adverse effect during TAI was abdominal discomfort (60.5%). Conclusion: We observed a sustained significant improvement in defecation symptoms and quality of life for 3 years in spina bifida children who underwent continuous TAI. INTRODUCTIONSpina bifida (SB) is a congenital impairment of neural tube closure that occurs between 24 and 26 days of gestation 1 and affects the lower spinal cord with variable severity of neural symptoms that include neurogenic bladder and bowel dysfunction. 2 Appropriate management often achieves urinary continence, but bowel continence is a major concern for patients with SB. 3 More than 50% of children and adolescents with SB do not achieve full bowel continence; 4 bowel dysfunction is a major obstacle to independence, activity, social integration and good quality of life (QoL). 5 For some children with SB, bowel dysfunction is more distressing compared with their impaired motor function. 6 Several methods are used to deal with constipation and fecal incontinence in children with SB, including conservative or pharmacological management, transanal irrigation (TAI) and surgical approaches. Different laxatives have been used with varying success; however, when the internal sphincter is not fully functional, fecal incontinence or soiling occurs. 1 Therefore, a more aggressive management approach is needed for bowel continence in many cases. The Malone antegrade continence enema procedure is one of the most useful techniques for resolving fecal incontinence in SB children, but the downside of this procedure is the necessity for surgery. 6 Therefore, conservative treatment should be first administered, and the efficacy of TAI may predict the efficacy of Malone antegrade continence enema on bowel manageme...

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Section: Instrumentsmentioning

confidence: 99%

Long-term outcome of transanal irrigation for children with spina bifida

et al. 2014

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“…2 Fecal incontinence is reported to be significantly more stressful than impaired motor function. 5 Fecal incontinence is the most important factor in the deterioration of the mental and emotional aspects of quality of life (QOL). 6 A wide range of medical problems, such as chronic constipation, megacolon, inadequate bladder emptying, urinary tract infection and shunt malfunction, and psychological problems such as psychosocial trauma, damage to self-esteem, negative impact on social interaction and delayed psychosocial development are associated with unsuccessful bowel programs.…”

Section: Introductionmentioning

confidence: 99%

The effects of transanal irrigation as a stepwise bowel management program on the quality of life of children with spina bifida and their caregivers

Choi

Shin

et al. 2013

Spinal Cord

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Study design: Experimental, prospective study. Objectives: Fecal incontinence and constipation affect the quality of life (QOL) of children with spina bifida and their caregivers. We evaluated the clinical efficacy of a stepwise bowel management program on QOL for children with spina bifida and their caregivers. Setting: Republic of Korea. Methods: Between December 2010 and April 2011, 53 children with constipation, fecal incontinence or both underwent a stepwise bowel management program at our spina bifida clinic. The children and their caregivers were evaluated before and after this program using a self-administered questionnaire. Results: Among the children, 11.3% received only oral laxatives and controlled well, 88.7% received transanal irrigation. After this program, the mean number of episodes of fecal incontinence per week, number of diaper changes and total time for bowel care decreased from 6.9 to 0.5 (P ¼ 0.004), from 1.6 to 0.2 (P ¼ 0.001) and from 27 to 15.9 min (P ¼ 0.003), respectively. Caregivers and children were able to leave their houses more often (P ¼ 0.006), and caregivers' bothersomeness, anxiety and depression due to bowel care decreased (Po0.001). Factors related to family relationships (P ¼ 0.265) and financial impact (P ¼ 0.071) improved, but not significantly. Conclusions: We observed significant improvement in defecation symptoms and QOL scores of spina bifida patients who underwent this program. We recommend that this simple therapeutic method be considered as a safe and valid choice for the treatment of chronic constipation and fecal incontinence.

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“…1 The defect in the lumbosacral spine affects the sensory and motor nerves supplying the skin and muscles of the perianal region. 2 The sensations in the region, as well as the motor functions of the striated muscles suffer, compromising the dynamics of continence and the normal process of stooling and leading to incontinence and constipation. [3][4] Neurogenic constipation has been treated by disimpaction of stools from the colon and rectum, administration of stool softeners, oral laxatives, digital evacuation and a healthy diet containing adequate bulk-forming items.…”

Section: Introductionmentioning

confidence: 99%

Transanal irrigation in myelomeningocele children: an alternative, safe and valid approach for neurogenic constipation

et al. 2010

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Study design: A total of 60 children with myelomeningocele referred to Spina Bifida Center of Rome (31 boys and 29 girls; aged 8-17 years) were treated with transanal irrigation for three months. Objective: To investigate whether transanal irrigation is a valid and alternative approach for neurogenic constipation in children with myelomeningocele. Methods: A questionnaire on bowel disturbances, quality of life and side effects was completed before the beginning and at the termination of the study. Setting: Italy Results: About 60% (36/60) of patients reported relief from constipation and 75% (12/16) for fecal incontinence. Wheelchair-bound and walking patients showed same high improvement of bowel habit. Mean (s.d.) scores before and after the study were: neurogenic bowel dysfunction total score: 17.5 (5.2) versus 8.5 (4.3) (Po0.001); digital stimulation of anorectum: 4.2 (2.8) versus 1.3 (2.5) (Po0.01); frequency of fecal incontinence: 5.5 (1.2) versus 1.3 (1.7) (Po0.01) and degree of general satisfaction: 3.0 (2.4) versus 7.7 (1.5) (Po0.001).We observed a reduction of urinary tract infections during the course of treatment: 14 total urinary tract infections (9 caused by Escherichia coli) before versus 6 (3) during treatment (Po0.01) Conclusion: Transanal irrigation in children with myelomeningocele is an alternative and relatively safe approach for managing neurogenic constipation; in fact, it improves bowel disturbances, quality of life and seems to reduce the risk of urinary tract infections.

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Bowel and Bladder Control of Children With Myelomeningocele: A Nordic Study

Cited by 86 publications

References 23 publications

Long-term outcome of transanal irrigation for children with spina bifida

Long-term outcome of transanal irrigation for children with spina bifida

The effects of transanal irrigation as a stepwise bowel management program on the quality of life of children with spina bifida and their caregivers

Transanal irrigation in myelomeningocele children: an alternative, safe and valid approach for neurogenic constipation

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