Pediatric Bowel Management Options and Organizational Aspects

Abstract

A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age.

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

“…Although, it can also be associated with a higher risk of leakage, wound infections, postoperative abdominal pain, and the need for additional interventions when compared to a Malone appendicostomy [ 64 , 65 ]; however, this statement is controversial [ 66 ]. As an alternative to a cecostomy, the appendix could be split based on its length with a detailed description of the technique covered in a related manuscript [ 17 ].…”

“…Children with both bladder and bowel neurogenic dysfunction might require both mechanical emptying of the colon (ACE flushes) and urinary diversion (Mitrofanoff/Monti channel). The decision-making on the use of the appendix in these cases has been described in a related manuscript [ 17 ]. As an alternative to an ACE procedure in these patients, TAIs can be utilized for bowel management [ 68 ] and prevent the use of the appendix for a Malone procedure.…”

“…The barriers leading to low adherence to transition include health literacy [ 92 , 93 , 94 ], difficult coordination of care, and long wait times [ 91 ]. For further information on the transition of care to adult specialties, please refer to a related manuscript [ 17 ].…”

“…A stepwise protocol for the evaluation and management of children with spinal anomalies helps achieve the desired long-term outcomes. The current review paper focuses on bowel management strategies for patients with spinal lesions as part of a manuscript series on BMP in children with colorectal diagnoses (anorectal malformations, Hirschsprung disease, functional constipation, and spinal anomalies) [ 17 , 18 , 19 , 20 ].…”

State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

“…Our goal is to report updates on a bowel management program (BMP) for patients with a pediatric colorectal diagnosis (anorectal malformation, Hirschsprung disease, spinal anomaly, and functional constipation) based on the recent literature [ 19 , 20 , 21 ]. The current manuscript reviews the anatomic features of patients with HD, management of obstructive episodes, soiling, HAEC, and total colonic HD.…”