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Pediatric Surgery International

, Volume 35, Issue 2, pp 243–245 | Cite as

Bowel management program in patients with spina bifida

  • Julie SchletkerEmail author
  • Tiffany Edmonds
  • Rebecca Jacobson
  • Jill Ketzer
  • Jennifer Hall
  • Andrew Trecartin
  • Alberto Peña
  • Andrea Bischoff
Original Article

Abstract

Purpose

Our center has been successfully implementing a bowel management program (BMP) for fecal incontinence consecutive to anorectal malformation and Hirschsprung disease. Recently, the number of patients with spina bifida requiring management for fecal incontinence has increased. The purpose of this study was to review the results of bowel management in patients with spina bifida and the challenges unique to this population.

Methods

A retrospective chart review was performed including all patients with spina bifida who attended our BMP from February 2016 until April 2018. Data collection included: prenatal intervention, gender, age, characteristics of contrast enema, success rateand challenges faced.

Results

Twenty-two patients met inclusion criteria 13 of which were females. Three patients had their myelomeningocele repaired prenatally, the remaining were repaired postnatally. Patient ages ranged from 2 to 24 years. Only nine patients were referred to BMP at proper toilet training age. Three patients came to BMP status post an antegrade enema procedure with reported “accidents” on their current regimen. The colon in the contrast enema was non-dilated in all patients and two behaved as hypermotile requiring loperamide. Seventeen patients (77%) were clean of stool and considered successful. Solution leakage during enema administration was the most common challenge and was corrected by increasing the Foley balloon fill volume.

Conclusions

Our bowel management program with enemas is effective for patients with a history of spina bifida. The data support specific considerations for this population including frequent adjustments, close follow-up and specific administration techniques.

Keywords

Spina bifida Bowel management Enema Fecal incontinence Neurogenic bowel Myelomeningocele Constipation 

References

  1. 1.
    Spina bifida fact sheet (2013) No. 13–309. National Institute of Neurological disorders and stroke. https://ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Spina-Bifida-Fact-Sheet. Accessed 23 Aug 2018
  2. 2.
    Data and Statistics on spina bifida (2018) Center for disease control and prevention. https://www.cdc.gov/ncbddd/spinabifida/data.html. Accessed 31 Aug 2018
  3. 3.
    Colares JH et al (2016) Impact of the bowel management program on the quality of life in children with fecal incontinence. Pediatr Surg Int 32(5):471–476CrossRefGoogle Scholar
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    Corbett P et al (2014) Peristeen integrated transanal irrigation system successfully treats faecal incontinence in children. J Pediatr Urol 10(2):219–222CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Julie Schletker
    • 1
    Email author
  • Tiffany Edmonds
    • 1
  • Rebecca Jacobson
    • 1
  • Jill Ketzer
    • 1
  • Jennifer Hall
    • 1
  • Andrew Trecartin
    • 1
  • Alberto Peña
    • 1
  • Andrea Bischoff
    • 1
  1. 1.Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children’s Hospital ColoradoUniversity of ColoradoAuroraUSA

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