How to establish a successful bowel management programme in children: a tertiary paediatric centre experience
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Bowel management is a term used to describe a medical approach to the management of faecal incontinence.
To present the outcomes of an individualised bowel management programme developed by a tertiary paediatric centre and evaluate contributory factors for successful bowel management in children.
A retrospective review of children attending a bowel management clinic in a tertiary centre in Dublin, Ireland, over 5 years (2010–2015). The main outcome measure was the ability to achieve a regular bowel pattern and remain socially clean. Multiple linear regression analyses were used to determine the factors contributing to successful bowel management.
One hundred ninety-two children attended the clinic over 5 years. The median age at commencement of washouts was 7 years. Underlying diagnosis was spina bifida in 50%, imperforate anus in 17.7%, Hirschsprung’s disease in 14.6%, idiopathic constipation in 7.8%, and other conditions in 9.9% of patients. Children with spina bifida and Hirschsprung’s disease preferred Peristeen washouts, while those with imperforate anus and idiopathic constipation preferred Willis washouts (p < 0.001). Our programme was successful in 93.7% of cases. Regression analysis showed that the underlying condition (p < 0.001), washout medication (p = 0.016), and individuals administering washouts (p < 0.001) contributed to a successful bowel management programme.
Treatment protocols should be individualised based on the underlying condition and outcomes. Decision-making must be cognisant of the physical, social, psychological, and developmental needs of the child and family. A partnership approach is advocated, which includes child and parent/carer preferences allowing them to make an informed decision.
KeywordsBowel management Bowel washout Children Constipation Faecal incontinence
Compliance with ethical standards
For this type of study, formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.
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