Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches

Abstract

Aims Spina Bifida (SB) is a rare congenital condition that frequently impairs the neurological control of both fecal continence and defecation. Several therapeutic strategies have been proposed but impact assessment is lacking. Our objectives were to quantify the symptomatic improvement and to determine the optimal strategy in this rare condition where randomized controlled trials are difficult to conduct. Methods Data were extracted from a prospective database. The present analysis focused on patients having undergone at least two gastroenterological assessments. A standardized therapeutic approach was used from the first visit. Improvement was quantified by the variation of quantified symptomatic scores. Results The data of of 57 adults with SB (gender F/M: 30/27 [52.6/47.4%]; mean age: 33.8 [18.5] years) were extracted. After a mean follow‐up of 46 months, 23/57 patients (40.4%) had at least improvement of one point of the Cleveland Clinic Incontinence score (CCIS); 13/57 (22.8%) reported a significant improvement of continence (delta score >50%). Five of the twelve patients (41.6%) with CCIS < 5 at baseline became incontinent over time. The neurological level was not associated with a worse continence outcome. Work on stool consistency and transanal irrigation were the most useful strategies in those with significant improvement of continence. Conclusions Using conventional strategies, a benefit on fecal continence occurs in only one out of five patients suffering from Spina Bifida and continent patients at baseline can develop fecal incontinence over time. A strategy targeting improved control of defecation (transanal irrigation) and a standardization of follow‐up protocol might be beneficial.

Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review

“…Hence, the maximum score for randomised trials was 28 and non-randomised studies 25. Studies were classified as being excellent (26)(27)(28), good (20)(21)(22)(23)(24)(25), fair (15)(16)(17)(18)(19) or poor (≤14) [18]. The assessment was independently performed by two reviewers (H.Ø.K.…”

“…In total, eleven studies were identified reporting data on the effect of TAI in NBD patients [7,[19][20][21][22][23][24][25][26][27][28]. The results are presented in Table 1.…”

“…The results are presented in Table 1. The articles were published between 2004 and 2019, and included one RCT [7], eight prospective cohort studies [19][20][21][22][23][26][27][28], one cross-sectional study [25] and one retrospective study [24]. Six studies included patients with various neurological disorders, primarily SCI [7,[19][20][21][22]24]; two studies included patients with SCI [23,25]; two studies included patients with MS [26,27]; and one study included patients with SB [28].…”

“…The articles were published between 2004 and 2019, and included one RCT [7], eight prospective cohort studies [19][20][21][22][23][26][27][28], one cross-sectional study [25] and one retrospective study [24]. Six studies included patients with various neurological disorders, primarily SCI [7,[19][20][21][22]24]; two studies included patients with SCI [23,25]; two studies included patients with MS [26,27]; and one study included patients with SB [28]. Eight studies only included patients using TAI [19][20][21][22][23][24]26,27], one study randomised to TAI or conservative treatment [7], and two studies included patients using conservative treatment, TAI or had surgical treatment [25,28].…”

“…Six studies included patients with various neurological disorders, primarily SCI [7,[19][20][21][22]24]; two studies included patients with SCI [23,25]; two studies included patients with MS [26,27]; and one study included patients with SB [28]. Eight studies only included patients using TAI [19][20][21][22][23][24]26,27], one study randomised to TAI or conservative treatment [7], and two studies included patients using conservative treatment, TAI or had surgical treatment [25,28]. In total, 308 patients using TAI were included with between 4 and 62 patients included in each study.…”