Colon Enemas for Fecal Incontinence in Patients with Spina Bifida

Velde, Saskia Vande; Biervliet, S. Van; Laecke, Erik Van; Bruyne, Ruth De; Verhelst, Hélène; Winckel, Myriam Van

doi:10.1016/j.juro.2012.09.007

Cited by 17 publications

(39 citation statements)

References 19 publications

(25 reference statements)

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“…In their study of MACE in patients with spina bifida, fecal continence was achieved in 6 of 7 children (86%) and 7 of 11 adults (64%). 8 In terms of surgical complications, our study showed very few complications. There were no serious complications, such as shunt infection, ileus and severe stomal stenosis requiring operative revision.…”

Section: Discussionmentioning

confidence: 55%

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Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

et al. 2013

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Study design: Retrospective chart review. Objective: To evaluate the clinical outcomes and factors influencing patient satisfaction with Malone antegrade continence enema (MACE) in patients with spina bifida. Setting: Japan. Methods: We performed retrospective analysis of 21 patients with spina bifida who underwent surgical creation of an MACE stoma. Clinical outcomes were evaluated by medical records, operative notes and mailed questionnaires. Patient satisfaction scores (SSs) were measured on a modified visual analog scale (VAS) from 1 to 10, and the factors influencing the SS were analyzed. Results: A 100% return rate for the mailed questionnaires was achieved. All patients underwent in situ appendicocecostomy with cecal plication. There was only one complication that required surgical revision. Regarding fecal continence, the overall success rate was 90%. Although 4 patients (19%) had severe irrigation pain and 4 patients (19%) found the washout time intolerably long, 18 (85%) of them were satisfied with the MACE procedure. Age at operation, experience of retrograde colonic enema (RCE), experience of stomal leakage, increased comfort at school or workplace and increased comfort at sleepovers significantly influenced SSs. Conclusion: MACE is a valuable option in achieving fecal continence in patients with spina bifida, with most patients being satisfied with the procedure. In our analysis, younger age at operation, previous experience of RCE, no stomal leakage and improvement of quality of life (enhanced comfort at school, workplace and sleepovers) significantly influenced the high satisfaction after MACE. Spinal Cord (2014) 52, 54-57; doi:10.1038/sc.2013.111; published online 1 October 2013Keywords: Malone antegrade continence enema; quality of life; patient satisfaction; fecal incontinence; spina bifida INTRODUCTIONThe Malone antegrade continence enema (MACE) procedure, which was first described in 1990 by Malone et al., 1 has revolutionized the management and improved the quality of life (QOL) of patients with spina bifida who suffer from refractory constipation and fecal incontinence. However, it has been reported in a long-term followup study that a considerable number of patients have ceased the MACE procedure. 2 To select good candidates for the MACE procedure among patients with spina bifida, it is important to evaluate not only the status of the bowel, but also the overall patient satisfaction after the procedure. The aim of this study was to evaluate the factors that influence overall satisfaction after the MACE procedure in patients with spina bifida.

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Section: Discussionmentioning

confidence: 55%

“…Hoekstra et al 6 reported relatively similar results of SS on almost the same scale from 1 to 10 in children with intractable defecation disorders. In their study, 86% of the patients were satisfied, with a median score of 8 (range, [6][7][8][9][10]. In this study, we analyzed the factors influencing patient satisfaction.…”

Section: Discussionmentioning

confidence: 95%

Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

et al. 2013

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“…44 Clinical data were collected using questionnaires, 6,7,[12][13][14][15]17,19,[23][24][25]29,30,34,35,37,43 neurogenic bowel dysfunction scales, 20,26,45 QoL questionnaires 4,16,21,22,27,28,31,32,38,41 or child behavior checklists. 4,31 The collection methods were interviews during follow-up visits 6,15,20,25,43 or telephone contacts 4,7,12,17,23,32,38 or both. 16,31,37,41 The follow-up period of SB patients after starting bowel management varied from 3, 15,…”

Section: Resultsmentioning

confidence: 99%

“…16,31,37,41 The follow-up period of SB patients after starting bowel management varied from 3, 15,19,20,22,23,41,42 over 12, 12,13,21,25,31 30 [16][17][18][27][28][29][30]34,39 and 60 months 24,32,33,35,36,40,43 to 120 months. 38,43 To explore different treatment modalities for bowel management in SB and their effectiveness the studies were grouped according to the treatment modality: conservative bowel management (16 studies), electrical stimulation (4 studies) and non-conservative (surgical) bowel management (17 studies).…”

Section: Resultsmentioning

confidence: 99%

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

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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.

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Anal Incontinence: Etiology and Clinical Treatment

Bhama

Steele

2020

Anorectal Physiology

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Colon Enemas for Fecal Incontinence in Patients with Spina Bifida

Abstract: Colon enemas are a valuable method in achieving continence. At our center medical followup from childhood to adulthood is associated with successful acquisition of fecal pseudocontinence.

Cited by 17 publications

References 19 publications

Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

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

Anal Incontinence: Etiology and Clinical Treatment

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