Article ; Online: Intermediate and long-term outcomes of a bowel management program for children with severe constipation or fecal incontinence.
2019 Volume 55, Issue 3, Page(s) 545–548
Abstract: Purpose: We sought to examine the long-term clinical success rates of a bowel management program (BMP) for children with severe constipation or fecal incontinence.: Methods: A single center review was conducted of children (≤18 years) enrolled in a ... ...
| Abstract | Purpose: We sought to examine the long-term clinical success rates of a bowel management program (BMP) for children with severe constipation or fecal incontinence. Methods: A single center review was conducted of children (≤18 years) enrolled in a BMP and followed in a colorectal specialty clinic (2011-2017). All patients who completed an initial week of the BMP were included. Patients enrolled in a BMP after 2018 were excluded. Success was defined as no accidents and <2 stool smears per week. Results: A total of 285 patients were reviewed. BMP was initiated at a median age of 7 years (9 months-17 years). Primary diagnoses included functional constipation (112), anorectal malformation (ARM) (104), Hirschsprung Disease (HD) (41), rectal prolapse (14), spina bifida (6), fecal incontinence (3) and other (5; 4 sacral coccygeal teratomas and a GSW to the buttocks). Initial bowel regimen included large volume enema in 54% and high dose stimulant laxative in 46%. The initial Bowel Management Week (BMW) was successful in 233 (87% of adherent patients) patients with 17 (6%) non-adherent. One hundred twenty-two patients had follow-up at 12 months (72% success amongst adherent patients, 7% of patient non-adherent) and 98 patients had follow-up at 24 months (78% success amongst adherent patients, 10% of patients non-adherent). 21/154 (14%) patients started on enemas were later successfully transitioned to laxatives and 13/132 (10%) patients started on laxatives subsequently required enemas in order to stay clean. Clinic phone contact occurred outside of scheduled visits for adjustment to the BMP in 44% of patients. 33% of patients had surgery to aid bowel management (antegrade colonic enema (ACE) = 81, resection + ACE = 13, diverting stoma = 4). Median follow up was 2.5 years (5 weeks-7 years). Conclusion: Children who follow a structured BMP with readily available personnel to provide outpatient assistance can experience successful treatment of severe constipation or fecal incontinence long-term. A multi-institutional collaboration is necessary to identify factors which predict failure of a BMP and non-adherence. Type of study: Single-center retrospective chart review. Level of evidence: 3. |
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| MeSH term(s) | Adolescent ; Child ; Child, Preschool ; Constipation/epidemiology ; Constipation/therapy ; Enema/statistics & numerical data ; Fecal Incontinence/epidemiology ; Fecal Incontinence/therapy ; Hirschsprung Disease ; Humans ; Infant ; Laxatives/therapeutic use ; Rectal Prolapse ; Retrospective Studies ; Treatment Outcome |
| Chemical Substances | Laxatives |
| Language | English |
| Publishing date | 2019-11-20 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 80165-3 |
| ISSN | 1531-5037 ; 0022-3468 |
| ISSN (online) | 1531-5037 |
| ISSN | 0022-3468 |
| DOI | 10.1016/j.jpedsurg.2019.10.062 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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