Retrograde continence enema in children with spina bifida: Not as effective as first thought

King, Sebastian K.; Stathopoulos, Lefteris; Pinnuck, Loreto; Wells, Judy; Hutson, John M.; Héloury, Yves

doi:10.1111/jpc.13408

Cited by 20 publications

(24 citation statements)

References 33 publications

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“…King et al reported also important drop out of nearly half of patients (11/20) with PT in a group of spina bifida patients. Reason for drop out: balloon loss in 4/20, too difficult procedure in 4/20 and pain in 3/20 patients (12). Better patient selection (age, underlying disease, personality type, intellectual/…”

Section: Discussionmentioning

confidence: 99%

Prospective switch study comparing two irrigation systems for transanal irrigation in children

Renterghem

Sladkov

Matthyssens

et al. 2021

AGEB

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Background and study aims: Transanal irrigation (TAI) is used in children to treat constipation and incontinence. Belgium has 2 systems available: Colotip® (cheaper, however not designed for TAI) or Peristeen®. Patients and methods: This patient-control switch study is the first to compare 2 TAI systems. Children regularly using Colotip® for TAI were asked to participate, after consent, a visual analogue scale (VAS) rating the system and a 2-week diary (fecal continence, self-reliance, time spent on the toilet, pain, Bristol stool scale, irrigation volume and frequency of enema) were completed. Non-parametric statistics were used. Results: Out of 26 children using Colotip®, 18 (69%) children participated and 5 refused (fear n=1, satisfaction Colotip® system n=7). Of these 18 children (interquartile range: 3-18 years, median 12.5 years, 9 girls) 5 patients stopped Peristeen® (pain n=1, fear n=1 and balloon loss n=3) and 2 were lost from follow up. Dropouts and included patients showed no statistical difference. In the 11 remaining patients, pseudo-continence (p 0.015), independence (p 0.01) and VAS score (p 0.007) were significantly better with Peristeen®, no difference was found in time spent on the toilet (p 0.288) and presence of pain (p 0.785). Conclusions: In children Peristeen® offered significantly higher pseudo-continence and independency. 30% refused participation because of satisfaction with the Colotip® and 30% spina bifida patients reported rectal balloon loss due to sphincter hypotony. To diminish Peristeen® failure, a test-catheter could be of value. Considering Colotip® satisfaction, both systems should be available. Patient selection for Peristeen® needs further research.

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Section: Discussionmentioning

confidence: 99%

Prospective switch study comparing two irrigation systems for transanal irrigation in children

Renterghem

Sladkov

Matthyssens

et al. 2021

AGEB

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“…In eight, enhanced quality of life was seen (significant results) (Ausili et al, 2010; Choi et al, 2015; Christensen et al, 2006,2008; Del Popolo et al, 2008; Kelly, Dorgalli, McLorie, & Khoury, 2017; Kim et al, 2013; Loftus et al, 2012). However, King et al (2017) reported no significant difference among users when compared with those no longer using TAI. Hamonet-Torny et al (2013) and Passananti et al (2016) presented no comparative (baseline) values but found that those still using TAI at follow-up experienced minor bowel dysfunction and found higher numbers of participants reporting mild or no problem, respectively.…”

Section: Resultsmentioning

confidence: 88%

“…The most commonly reported adverse effect when using TAI was abdominal pain/discomfort, seen in eight studies (Ausili et al, 2010; Choi et al, 2015; Christensen et al, 2006; Faaborg et al, 2009; Kim et al, 2013; King et al, 2017; López Pereira et al, 2010; Patel et al, 2020). Other more common adverse effects were anorectal/perianal irritation/discomfort (Ausili et al, 2010; Christensen et al, 2006; Kim et al, 2013; Passananti et al, 2016; Patel et al, 2020), minor anal/rectal bleeding (Choi et al, 2015; Faaborg et al, 2009; Kim et al, 2013; Passananti et al, 2016), sweating (Ausili et al, 2010; Christiansen et al, 2006; Faaborg et al, 2009; López Pereira et al, 2010), fatigue (Faaborg et al, 2009; Kim et al, 2013), and/or general discomfort (Ausili et al, 2010; Christensen et al, 2006; Faaborg et al, 2009).…”

Section: Resultsmentioning

confidence: 99%

“…In eight, reduced constipation was seen (Ausili et al, 2010, 2018; Christensen et al, 2006, 2008; Loftus, Wallace, McCaughey, & Smith, 2012; Midrio et al, 2016; Patel, Hopson, Bornstein & Safder, 2020; Preziosi et al, 2012). In one, no difference was seen between users and those no longer using TAI (King et al, 2017) and in another, no comparison was made (Hamonet-Torny et al, 2013). In two studies, significantly fewer participants had a feeling of incomplete evacuation after implementation of TAI (Del Popolo et al, 2008; López Pereira et al, 2010).…”

Section: Resultsmentioning

confidence: 99%

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Transanal Irrigation for People With Neurogenic Bowel Dysfunction

Boman

Nylander

Oja

2022

Gastroenterology Nursing

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Transanal irrigation has been introduced as a complement to standard bowel care for people with neurogenic bowel dysfunction. There is no contemporary integrative review of the effectiveness and feasibility of transanal irrigation from a holistic nursing perspective, only fragments of evidence to date. The aim was to investigate the effectiveness and feasibility of transanal irrigation for people with neurogenic bowel dysfunction. An integrative literature review was conducted. Nineteen studies were included. According to the results, transanal irrigation can reduce difficulties associated with defecation, episodes of incontinence, and the time needed for evacuation and bowel care. Transanal irrigation can increase general satisfaction with bowel habits and quality of life and decrease level of dependency. However, there are practical problems to overcome and adverse effects to manage. Discontinuation is relatively common. The results support the effectiveness of transanal irrigation, but feasibility is inconclusive. Users, including caregivers, report practical problems, and compliance was not always easy to achieve. It is important that users, including caregivers, are well informed and supported during transanal irrigation treatment, especially during introduction. The quality of the studies found was generally weak; therefore, high-quality quantitative and qualitative studies are needed on the topic.

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“…Very few studies report compliance to digestive tract treatments, but they are often weaker (less than 50%). 28 The two main causes of discontinuation of treatment were lack of efficacy (21.1%) and the occurrence of FI due to loose stools (13.5%). This highlights the importance of obtaining stools of normal to hard consistency.…”

Section: Discussionmentioning

confidence: 99%

Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches

Brochard

Peyronnet

Hascoët

et al. 2018

Neurourology and Urodynamics

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Aims Spina Bifida (SB) is a rare congenital condition that frequently impairs the neurological control of both fecal continence and defecation. Several therapeutic strategies have been proposed but impact assessment is lacking. Our objectives were to quantify the symptomatic improvement and to determine the optimal strategy in this rare condition where randomized controlled trials are difficult to conduct. Methods Data were extracted from a prospective database. The present analysis focused on patients having undergone at least two gastroenterological assessments. A standardized therapeutic approach was used from the first visit. Improvement was quantified by the variation of quantified symptomatic scores. Results The data of of 57 adults with SB (gender F/M: 30/27 [52.6/47.4%]; mean age: 33.8 [18.5] years) were extracted. After a mean follow‐up of 46 months, 23/57 patients (40.4%) had at least improvement of one point of the Cleveland Clinic Incontinence score (CCIS); 13/57 (22.8%) reported a significant improvement of continence (delta score >50%). Five of the twelve patients (41.6%) with CCIS < 5 at baseline became incontinent over time. The neurological level was not associated with a worse continence outcome. Work on stool consistency and transanal irrigation were the most useful strategies in those with significant improvement of continence. Conclusions Using conventional strategies, a benefit on fecal continence occurs in only one out of five patients suffering from Spina Bifida and continent patients at baseline can develop fecal incontinence over time. A strategy targeting improved control of defecation (transanal irrigation) and a standardization of follow‐up protocol might be beneficial.

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Retrograde continence enema in children with spina bifida: Not as effective as first thought

Abstract: We demonstrated a high rate of cessation with RCE in patients with spina bifida. This could not be explained by associated conditions, or by enema-related parameters. One possible explanation is the lack of ongoing outpatient support for the children and their families.

Cited by 20 publications

References 33 publications

Prospective switch study comparing two irrigation systems for transanal irrigation in children

Prospective switch study comparing two irrigation systems for transanal irrigation in children

Transanal Irrigation for People With Neurogenic Bowel Dysfunction

Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches

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