The Effectiveness of Irrigation Systems in Managing Fecal Soiling in Children. A Single Center Experience

Abstract

Purpose To evaluate saline enema success and the effectiveness of irrigation system in managing fecal soiling in pediatric patients with colorectal condition. Methods A retrospective cohort chart review of pediatric patients attending a bowel management clinic in a tertiary center in Riyadh, Saudi Arabia over 15months period (January 2022- March 2023). We included all pediatric patients (age 3–18 years) enrolled in bowel management program at our center, who are on saline enema protocol using the available irrigation system. Antegrade colonic enema or retrograde enema were used in managing fecal soiling. Patients with colorectal conditions having true fecal incontinence or constipation with pseudo incontinence were enrolled. Idiopathic constipation, spina bifida, neurogenic disorder and cloaca exstrophy were excluded. Results Forty-one patients who attended the clinic over one year were included. Thirty- five (85.4%) had true fecal incontinence, and 6 (14.6%) had constipation (overflow pseudo-incontinence). The majority were boys 30 (73.2%). Underlying disorders were anorectal malformation 27 (65.9%), cloaca anomaly 8 (19.5%), and Hirschsprung’s disease 6 (14.6%). Methods used in irrigation/saline enema administration varied, 31 (12.7%) were on trans-anal (regular Foley catheter, balloon tip catheter, cone tip catheter), 8 (19.5%) were on antegrade irrigation (Malone, neo-Malone and cecostomy) using (Nelton/feeding tube catheter), and 2 (4.9%) were on trans-stoma (cone tip catheter). Thirty-five (85.4%) succeeded and remained completely clean in the underwear for 24 hours till the next enema, 3 (7.3%) failed and were not clean between enema, 2 lost follow up, and 1on hold. The reasons for failure were either compliance or short colon or damaged internal canal. The utilization of different irrigation systems improved the noncompliance rate in 7 patients (2.9%). Conclusion Bowel management program has proved successful in many countries since its implementation. The underlying conditions remain the main determinant of success as well as a significant factor in the failure of any program. However, considering the compliance in pediatric age group, few are still facing some degree of social embarrassment with accidents. When it comes to compliance, utilizing different available irrigation systems is helpful.