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

(1) Background: Bowel management contributes throughout the pathway of care for children with Hirschsprung. Preoperative bowel management prepares the child and family for the pull-through surgery. Perioperative bowel management supports early recovery and tailored bowel management in the follow-up supports the achievement of social continence. (2) Methods: We conducted a cross-sectional assessment of our institutional bowel management program to illustrate the pre-, peri- and postoperative bowel management strategies. (3) Results: A total of 31 children underwent primary pull-through, 23 without a stoma and 8 with a stoma, at a median age of 9 months. All children without a stoma were prepared for surgery by using rectal irrigations. Children with a stoma were prepared for surgery with a transfer of stoma effluent. Transanal irrigation supported early recovery. (4) Conclusions: Bowel management is a key pillar of the management of children with Hirschsprung disease. Incorporating bowel management in the pathway of care facilitates primary pull-through and supports perioperative recovery.

Section: Discussionmentioning

confidence: 99%

Section: Education and Support For Familiesmentioning

confidence: 99%

Bowel Management in Hirschsprung Disease—Pre-, Peri- and Postoperative Care for Primary Pull-Through

Lindert,

Schulze,

Märzheuser

2024

“…The causes of soiling are myriad, and the care of these patients requires understanding when fecal incontinence should be anticipated as well as the surgical options available to help a patient achieve continence [49]. Bowel management programs and their techniques have dramatically improved many patients' quality of life and require an institutional commitment to a nursing team [50][51][52][53].…”

Section: Management Of Functional Constipation Colonic Dysmotility An...mentioning

confidence: 99%

Is Collaborative Care the Future of Medicine? Lessons Learned from the Care of Children with Colorectal Conditions

Choueiki,

Sales,

Callicott

et al. 2024

Self Cite

The treatment of patients with colorectal disorders requires care from a wide variety of medical and surgical specialties over the course of their lifetime. This is ideally handled by a collaborative center which facilitates the assessment and development of patient care among multiple specialties which can enhance the quality and implementation of treatment plans, improve communication among different specialties, decrease morbidity, and improve patient satisfaction and outcomes. This collaborative approach can serve as a model for other parts of medicine requiring a similar multi-disciplinary and integrated method of care delivery. We describe the process, as well as the lessons learned in developing such a program.

“…A stepwise algorithm of evaluation and bowel management in children with spinal lesions is demonstrated in Figure 3 . The first evaluation step is obtaining the medical history, physical examination, and a contrast enema to assess the stool burden [ 20 ]. A nondilated colon on a contrast study is characteristic of patients with spinal anomalies and can be present in both hypo- and hypermotility cases [ 6 ].…”

Section: Bowel Management Protocolmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Bokova,

Prasade,

Rosen

et al. 2023

Self Cite

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.