Bowel function and care: Guidelines for the care of people with spina bifida

Abstract

PURPOSE: Bowel dysfunction, such as constipation and fecal incontinence, has a significant impact on health, activities of daily living, and quality of life among people with spina bifida. Secondary complications may result from bowel dysfunction and include urologic dysfunction, loss of skin integrity, shunt (hydrocephalus) function, as well as loss of social opportunities and employability. METHODS: Using a consensus building methodology, the guidelines for management of bowel dysfunction in spina bifida were written by experts in the field of spina bifida and bowel function and care. RESULTS: The evidence-based guidelines are presented in table format and provide age-specific recommendations to achieve fecal continence without constipation. Recommended treatments are presented from least to most invasive options. Literature supporting the recommendations and the interval research published to date is also presented. CONCLUSION: These guidelines present a standardized approach to management of bowel dysfunction in spina bifida. Bowel management in children and young adults with spina bifida is limited by variability in clinical practice and paucity of robust research in neurogenic bowel. Collaborative multi-institutional efforts are needed to overcome research barriers and provide innovative solutions.

Self-management and independence guidelines for the care of people with spina bifida

“…Evidence [66] 9. Consider using an age-and condition-appropriate assessment instrument especially if the child has executive-functioning impairments (Table 3).…”

“…Evidence [21,23,66,70,71] -Support development of skills necessary for self-management (e.g., decisionmaking, goal-setting, self-regulation, and communication).…”

“… Assess bladder and bowel management programs for eventual independent self-management. Evidence [ 66 ] 9. Consider using an age- and condition-appropriate assessment instrument especially if the child has executive-functioning impairments (Table 3 ).…”

“… Evidence [ 13 , 60 , 32 , 46 , 69 ] Encourage increasing responsibility for behaviors such as management of medication, bowel and bladder programs, and skin-monitoring. Evidence [ 21 , 23 , 66 , 70 , 71 ] Support development of skills necessary for self-management (e.g., decision-making, goal-setting, self-regulation, and communication). Evidence [ 6 , 16 ] Evaluate and monitor cognitive functions as they underpin decision-making, goal-setting, self-regulation, self-management, socialization, and transition issues.…”

“Bowel Management” program for children with congenital malformations and neurogenic bowel after surgery

“…Для решения этих проблем использовали солевой раствор (0,9-1 % NaCl) как базовый, при неэффективности добавляли ирритант -жидкий глицерин в объеме от 5 до 40 мл, который усиливал моторику кишки и улучшал опорожнение. Для удержания раствора в кишке в течение 10 мин использовали катетер Фолея большого диаметра (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). В баллон катетера, заведенного в прямую кишку, инсуффлировали воздух до 30 мл, тем самым создавая обтурационную пробку, предотвращающую подтекание раствора.…”