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

Abstract

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...

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

“…Importantly, introduction or modification of a treatment by transanal irrigation was significantly associated with improvement of fecal continence. The effectiveness and the safety of this treatment had been documented in the treatment of constipation and FI of children, adults, and spinal cord‐injured patients . This study highlights the effectiveness of transanal irrigation on FI of SB patients in real life.…”

“…The effectiveness and the safety of this treatment had been documented in the treatment of constipation and FI of children, adults, and spinal cordinjured patients. [23][24][25][26] This study highlights the effectiveness of transanal irrigation on FI of SB patients in real life. On the other hand, the combination of laxatives or softeners with transanal irrigation is no more effective than the use of transanal irrigation alone.…”

Advanced Management Protocol of Transanal Irrigation in Order to Improve the Outcome of Pediatric Patients with Fecal Incontinence

“…However, while some authors report constant results of efficacy in short- and long-term studies, in some cases a reduction of the success rate during follow-up is described [ 7 , 10 ]. In the literature, several studies show the high efficacy of Peristeen ® in several organic diseases, as well as in functional disorders [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ]; however, to our knowledge, there are no studies comparing the effectiveness of TAI in patients affected by different pathologies. Furthermore, the actual best practices, which are very useful in the management of children with fecal incontinence, originate from protocols defined on adult patients.…”

Estreñimiento funcional en pediatría, diagnóstico y tratamiento Grupo de Trabajo de Constipación del Comité Nacional de Gastroenterología Pediátrica

“…La irrigación transanal rectal/colónica es un procedimiento en el que se infunde agua en el recto para realizar una limpieza intestinal mecánica y se utiliza, principalmente, en niños con estreñimiento e incontinencia de causa neurogénica (como espina bífida, EH o malformaciones anorrectales). 37,38 Sin embargo, los datos sobre su efectividad en pediatría son escasos. Las irrigaciones suelen realizarse con un volumen de agua de 10-20 ml/kg.…”