Faecal incontinence in children with spina bifida: The best conservative treatment

Abstract

Incontinence is one of the major stigmata a ecting the quality of life of the myelodysplastic patient. The appropriate management of the neuropathic bladder has led most patients to survive with good conditions. Major advances have also been made in the treatment of faecal incontinence for enabling patients to achieve their full potential, to become integrated in society and to be as independent as possible. We present the results of the Retrograde Colonic Enema (RCE) in 33 patients su ering neurogenic faecal incontinence. We believe that the RCE is one of the best conservative methods of treatment for relieving faecal incontinence originating from spina bi®da and other neurological problems with intestinal dysfunction.

An evidence-based review of the use of transanal irrigation in children and young people with neurogenic bowel

“…The definitions used to define continence/ Transanal irrigation in children and young people L Bray and C Sanders Transanal irrigation in children and young people L Bray and C Sanders incontinence and constipation varied between studies. Definitions and criteria to judge incontinence varied from any episodes or incidences of staining, soiling or faecal incontinence, 4,6,9,11,12,19 soiling once a month, 10 soiling three times a month, 16 not needing to wear pads for stool incontinence 13 to no information being supplied on how the studies had characterised continence or incontinence. 5,14,15,17,18 This review has correlated with the studies, whose report rates of continence were achieved.…”

“…Transanal irrigation was reported as improving the continence in 346 from 383 (90%) children using transanal irrigation at the point of follow-up in the various studies. 4,6,[9][10][11]14,16,17,19 The reports of continence achieved within this figure ranged from 66% 14 to 100% 11,16 (Table 2).…”

“…Some studies do not report rates of faecal continence achieved 7 and report outcomes as those satisfied with the regime, 5 those still using the procedure at the point of follow-up 18 or improved bladder function. 13 Saline (either isotonic or made by families within the home) was used to irrigate the bowel in 8 of the 17 studies, 4,7,12,[15][16][17][18][19] which included 495 children. Tap water was used in 7 of the studies, 5,6,8,[9][10][11]14 which in total included 270 children.…”

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

“…25 A subsequent report on the Shandling catheter described the achievement of continence in 32 of 33 patients (aged 5-22 years with spina bifida and faecal incontinence), which was maintained during follow-up of 24-35 months, with the exception of a single child who had undergone three surgical procedures for rectal prolapse. 26 A 30-month follow-up study evaluated TAI with saline using the Enema Continence Catheter in 30 children with spina bifida and in 1 child with SCI. 27 During the study, the proportion of children with continent stools increased from 28 to 94% (Po0.01) and the proportion of constipated stools decreased from 55 to 15% (Po0.01).…”

“…19 Two long-term (10-year) follow-up studies in adults and children 20,21 reported success rates of 50% (n ¼ 32) using a rectal balloon catheter, cone-shaped colostomy tip or other system 20 and of 67% (n ¼ 18) using TAI with Peristeen or a cone-shaped colostomy tip. 21 Although less robust than data in patients with SCI, taken together, these data show that TAI can reduce constipation 27 and achieve faecal continence in both children [23][24][25][26][28][29][30] and adults 31 with spina bifida, achieving an improvement in symptoms, 27 independence 23 and quality of life, 30 and remaining effective in the long term. 16,20,21 Efficacy of TAI in patients with multiple sclerosis and other causes of NBD At present, the majority of data on the efficacy of TAI in patients with multiple sclerosis comes from observational studies ( Table 1).…”