Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele

Kelly, Maryellen S.; Wiener, John S.; Liu, Tiebin; Patel, Priya; Castillo, Heidi; Castillo, Jonathan; Dicianno, Brad E.; Jasien, Joan; Peterson, Paula; Routh, Jonathan C.; Sawin, Kathleen J.; Sherburne, Eileen; Smith, Kathryn A.; Taha, Asma A.; Worley, Gordon

doi:10.3233/prm-190667

Cited by 15 publications

(24 citation statements)

References 27 publications

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“…Nevertheless, similar to the other outcomes in some instances where drastically superior results were achieved such as a rate of close to 20% incontinence in patients reported by Behbahani et al from Lurie Children’s Hospital [ 23 ]. As outlined in our results and reported previously, there is a correlation between the urinary and bowel continence and school attendance [ 31 ]. This finding may be emphasized in settings with limited special education facilities, like the present study.…”

Section: Discussionsupporting

confidence: 87%

2- to 20-year myelomeningocele follow-up outcomes from a referral center in Southern Iran: the Shiraz experience

Zoghi,

Mosayebi,

Feili

et al. 2024

Eur J Med Res

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Background The current convention for treatment of children with myelomeningocele (MMC) is timely surgical intervention combined with long-term follow-up by a multidisciplinary specialized team. This study aims to investigate the outcomes of MMC patients treated at Namazi Hospital. Methods All children presenting to Namazi Hospital with myelomeningocele between May 2001 and August 2020 were eligible for this study. For those with a documented telephone number, follow-up phone surveys with the patient’s caregivers, on top of the review of the medical documents were carried out to assess mortality, morbidities, and the functional outcome of the care provided to them. Results A total of 125 patients were studied (62 females). All of the patients were followed up for a mean duration of 6.28 years (range 1–23 years). The majority were located in the lumbosacral area. All of the patients underwent postnatal surgical intervention for MMC in Namazi Hospital. Mean age at surgery was 9.51 days. There were statistically significant differences between urinary and bowel incontinence and presence of scoliosis, MMT grading of the lower limbs, school attendance, number of readmissions, and requirement of laminectomy at the initial surgical intervention. Conclusions This study is the first to characterize the long-term outcomes of MMC patients in Iran. This study illustrates that there is a great need for improved access to and coordination of care in antenatal, perioperative, and long-term stages to improve morbidity and mortality.

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Section: Discussionsupporting

confidence: 87%

2- to 20-year myelomeningocele follow-up outcomes from a referral center in Southern Iran: the Shiraz experience

Zoghi,

Mosayebi,

Feili

et al. 2024

Eur J Med Res

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“…Due to the increased time required for bowel emptying with ACE flushes, and insufficient mobility of some patients with spinal lesions to administer rectal enemas or TAIs, fecal diversion might be the optimal treatment option taking much less time [ 22 ]. Kelly et al reported the highest independence rates achieved with fecal diversion (63%), followed by ACE flushes (49%), rectal enemas (22%), and TAIs (13%) as demonstrated in Figure 2 [ 35 ].…”

Section: Factors Affecting Continence and Treatmentmentioning

confidence: 99%

State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies

Bokova,

Prasade,

Rosen

et al. 2023

Children

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Background: Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. Methods: To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. Results: Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22–71% of patients achieve social continence dependent on the type and level of the lesion. Conclusion: Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient’s age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers.

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“…Various studies show that surgical treatment of NBD can be effective in supporting an enhanced QoL if properly indicated and with patients carefully selected 63 . However, a recent study found that roughly 40% of paediatric and adult patients with NBD attributable to myelomeningocele require surgery (due to failure of medical treatment) in order to attain faecal control 101 . Most reports on surgical treatment of NBD deal with adult patients and very little has been published on children and adolescents on this topic.…”

Section: -Lmentioning

confidence: 99%

Overview On Neurogenic Bowel Dysfunction in Pediatrics

Fadl¹,

D²,

Bedair

et al. 2022

Int J Life Sci Pharm Res

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Neurogenic bowel dysfunction (NBD) is fecal incontinence or constipation which is prevalent in kids with both congenital and acquired neurological disorders. NBD results from loss of normal sensory or motor control and may include both the upper and the lower gastrointestinal (GI) tract Constipation and fecal incontinence are frequent symptoms of neurogenic bowel dysfunction (NBD), which makes it a challenging condition to treat. Also, they have a major impact on quality of life and dignity. Bowel dysfunction is less studied compared to neurogenic bladder, generally prevelant in spina bifida, but practically as prevalent in other neurological conditions. Generally, the objective of neurogenic bowel management is to achieve complete emptying of the rectum on a systematic basis. This may be accomplished through with a multidimensional approach containing of conservative, medical and even surgical approaches. A modified Delphi procedure was used to construct a statement document. This paper discusses the various causes of paediatric NBD. Our aim is to enhance clinical management, numerous therapeutic techniques are given. Due to both the improved survival rate and better diagnosis, there are more children and teenagers with NBD. The number of children and adolescents with NBD is growing as a result of better diagnosis and a greater survival rat NBD can cause either faecal incontinence or constipation, or both, with a fair amount of predictability. However, each patient will experience NBD in a different way depending on a variety of underlying conditions and coexisting conditions. Due to the status of the affected child and caregivers, management of NBD should be individualized using a combined multidisciplinary therapy.

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Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele

Cited by 15 publications

References 27 publications

2- to 20-year myelomeningocele follow-up outcomes from a referral center in Southern Iran: the Shiraz experience

2- to 20-year myelomeningocele follow-up outcomes from a referral center in Southern Iran: the Shiraz experience

State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies

Overview On Neurogenic Bowel Dysfunction in Pediatrics

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