A structured bowel management program for patients with severe functional constipation can help decrease emergency department visits, hospital admissions, and healthcare costs

Reck-Burneo, Carlos A.; Vilanova-Sánchez, Alejandra; Gasior, Alessandra C.; Dingemans, Alexander J.M.; Lane, Victoria A.; Dyckes, Robert; Nash, Onnalisa; Weaver, Laura; Maloof, Tassiana; Wood, Richard J.; Zobell, Sarah; Rollins, Michael D.; Levitt, Marc A.

doi:10.1016/j.jpedsurg.2018.03.020

Cited by 28 publications

(16 citation statements)

References 9 publications

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“…A systematic review of 27 studies (1 RCT and 26 case studies) on the role of biofeedback in DES in paediatric patients showed a rate of improvement from 18% to 100% for constipation and of 83% in cases of UTI [50]. In children with severe constipation, a structured bowel management program decreases unplanned visits to the emergency department, hospital admissions, and costs for constipation-related health care for constipationrelated morbidities (abdominal pain 39%, fecal impaction 17%, urinary retention 2.2%, urinary tract infections 14%) [51].…”

Section: Discussionmentioning

confidence: 99%

Management of constipation in preventing urinary tract infections in children: a concise review

Zaffanello

Baratto

Piacentini

2019

The European Research Journal

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Objectives: Constipation is a common problem in children. Chronic functional constipation (CFC) has been a claimed conditions that may increase the risk for urinary tract infections (UTIs). Dysfunctional voiding (DV) and lower urinary tract dysfunctions (LUTD) with chronic constipation are referred to dysfunctional elimination syndromes (DES). The aim of the present review is to look at the management of constipation in children with CFC or DES in reducing the risk of recurrent UTIs. Methods: We performed a literature search on electronic databases (Pubmed and Scopus) for relevant clinical trials investigating the results of one or more treatments for children's constipation in the term of UTIs recurrence. Results: The search strategy identified 20 valuable clinical trials. The studies are not homogenous but showed an improvement in UTIs occurrences in children managed for bowel dysfunction. Conclusion: In conclusion, children referred to a pediatric nephrologist for UTIs should include an inquiry bowel habits and those with a positive assessment for bowel dysfunction needs the collaboration with a pediatric gastroenterologist with a multidisciplinary approach.

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Section: Discussionmentioning

confidence: 99%

Management of constipation in preventing urinary tract infections in children: a concise review

Zaffanello

Baratto

Piacentini

2019

The European Research Journal

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“…The medical treatment options are digital evacuation of the impacted fecal mass, the rectal administration of stool softening agents, usually enemas or suppositories, and orally administered laxatives, such as polyethylene glycol (PEG) 3350 with electrolytes. [1,9,10] In many cases, manual disimpaction is required. The procedure is done using lubrication and gently removing the impacted stool with the index finger, and can be aided with the use of an anoscope and suction.…”

Section: Discussionmentioning

confidence: 99%

Massive fecal impaction with megarectum formation: A case report

Erdoğan¹

2019

South Clin Ist Euras

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Fecal impaction occurs because of hardened fecal matter retained in the colorectum which cannot be evacuated by peristaltic activity. Fecal impaction commonly occurs among nursing home residents, patients with neurological deficit, psychiatric disease or renal failure. Fecal impaction is usually treated by manual disimpaction, enemas and laxatives. Laparotomy is required only in the presence of complications. We herein report a case of a massive fecal impaction with megarectum in a 62-year-old woman who presented with large bowel obstruction. The aim of this report is to give a brief review of this entity and discuss the treatment options for these cases.

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“…Bowel management programs (BMPs) are a well-established clinical strategy used to remedy life-altering fecal incontinence and severe constipation in children with anorectal malformations (ARMs), Hirschsprung's disease, myelomeningoceles, spina bifida, other neurogenic bowel disorders, and functional constipation [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] . During BMPs, patients are treated with tailored bowel regimens including laxative medications and antegrade or retrograde enemas and assessed with abdominal x-rays and patient-reported information to achieve improvements in constipation or incontinence.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of a telemedicine bowel management program during COVID-19

Knaus

Ahmad

Metzger

et al. 2022

Journal of Pediatric Surgery

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Purpose Due to the COVID-19 pandemic, we transitioned from an in-person bowel management program (BMP) to a telemedicine BMP. The telemedicine BMP consisted of video and/or phone call visits (remote) or a single initial in-person visit followed by remote visits (hybrid). We hypothesized that patient/family satisfaction of a telemedicine BMP would be comparable to an in-person BMP and that there would be improvement in quality of life and functional outcomes after the telemedicine BMP. Methods After IRB approval, demographic and outcomes data were obtained for patients who underwent the telemedicine BMP from May-October 2020. Outcomes included a parent/patient satisfaction survey, Pediatric Quality of Life Inventory (PedsQL), and parent/patient-reported outcome measures (Vancouver, Baylor, and Cleveland scores) at baseline, 1-, and 3-month follow-up. Variables were compared using Chi-square or Wilcoxon–Mann–Whitney tests and a generalized mixed model was used to evaluate outcomes scores at follow-up compared to baseline. Results Sixty-seven patients were included in our analysis with an average age of 8.6 years (SD: 3.9). Patients had the following diagnoses: anorectal malformation (52.2%), Hirschsprung's disease (20.9%), functional constipation (19.4%), myelomeningocele (6.0%), and spinal injury (1.5%). Forty-eight patients (72%) underwent the remote BMP and 19 (28%) underwent the hybrid BMP. Sixty-two percent of parents completed the satisfaction survey, with a median score of 5 (very satisfied) for all questions. Over 75% of parents said they would prefer a telemedicine program over an in-person program. There was significant improvement in the Baylor and Vancouver scores after the BMP (p<0.01), but no difference in the PedsQL or Cleveland scores (p>0.05). There was a significant improvement in stool continence after the BMP (p<0.01). Conclusion A telemedicine BMP can be an acceptable alternative to a traditional in-person program. There was high parental/patient satisfaction and significant improvement in outcomes. Further research is needed to assess long-term outcomes.

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A structured bowel management program for patients with severe functional constipation can help decrease emergency department visits, hospital admissions, and healthcare costs

Cited by 28 publications

References 9 publications

Management of constipation in preventing urinary tract infections in children: a concise review

Management of constipation in preventing urinary tract infections in children: a concise review

Massive fecal impaction with megarectum formation: A case report

Outcomes of a telemedicine bowel management program during COVID-19

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