Daily Enemas for Pediatric Bowel Management

Abstract

Introduction Children born with anorectal malformations, Hirschsprung disease, spinal cord defects, and related conditions have problems with constipation and fecal incontinence. In a large pediatric healthcare center, a weeklong outpatient program is offered to families, teaching daily high-volume enema administration. The purpose of this study is to assess the rate of adherence with daily enemas for bowel management and assess problems among children with elimination abnormalities. Methods A single-cohort observational study was conducted. Subjects included children ages 3–18 years and their parents who had attended a bowel management training program from April 2012 to December 2017. Data were collected utilizing an anonymous REDCap survey. Survey questions addressed adherence with daily enemas, supports and challenges, and parent-reported satisfaction and child acceptance. Results Surveys were sent to 112 parents, and 32 parents had completed the surveys. Approximately half of the sample, with a mean age of 9.9 years (SD = 3.7), adhered to daily enemas for bowel management. Parents reported a variety of problems and barriers to adherence with daily enemas, including child resistance (31.3%), difficulty retaining enema fluid (37.5%), cramping during enema (62.5%), time constraints (40.6%), getting or replacing equipment (28.1%), and bathroom space issues (25.0%). Sixty percent of the sample reported that enema administration requires more than 1 hour. Discussion In general, parents reported child acceptance, satisfaction, and limited difficulty with enema management; however, adherence was not as desired, and the rate of reported problems was high. Insight into problems experienced by parents provides nursing opportunity for educational programs that may improve adherence.

Health Literacy Implementation Principles: Pediatric Colorectal Program Development

“…Patients and families undergoing a BMP have lived the devastating effects of FI and have not responded to conventional therapies (Halleran et al, 2019; Nash et al, 2020; Reck-Burneo et al, 2018). Many have reduced adherence leading to increased use of healthcare resources, high healthcare costs, and morbidity and mortality (Librizzi et al, 2017; Mantel et al, 2019; Rollins et al, 2022). The Burden of Treatment Theory, proposed by minimally disruptive medicine scientists May et al (2014), postulates that additional demands are placed on patients with chronic illness, creating a proactive “patient-hood” that requires increased accountability and self-actualization.…”

Pharmacology

“…To achieve continence, regular elimination of stool is necessary and often achieved through oral laxatives, suppositories, and enemas. For those who do not respond to oral medications, transanal irrigation, and antegrade continence enema are alternative options (Mantel et al, 2019).…”