The effects of transanal irrigation as a stepwise bowel management program on the quality of life of children with spina bifida and their caregivers

Choi, Eun Kyoung; Shin, Seung Heon; Im, Young Jae; Kim, M. J.; Han, Sang Won

doi:10.1038/sc.2013.8

Cited by 53 publications

(60 citation statements)

References 24 publications

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“…Regular and complete bowel movements have many social and psychological benefits, 14 including the reduced likelihood of confinement to the house because of bowel care, decreased caregiver emotional stress and improved family relationships. However, in terms of travel and socialization, the QoL was decreased at the longterm follow-up examination compared with that at the short-term follow-up examination.…”

Section: Resultsmentioning

confidence: 99%

“…8 From the late 1990s, this method has been used in SB children and several researchers have reported its effectiveness and safety for neurogenic bowel management. 6,[9][10][11][12][13][14][15][16] These studies show that TAI reduces constipation and achieves fecal continence in children with SB, resulting in an improvement in independence and QoL. Up until the late 1990s, Malone antegrade continence enema was considered the last of all golden standards for bowel management in children with SB.…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcome of transanal irrigation for children with spina bifida

et al. 2014

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Study design: Experimental, prospective study. Objectives: We evaluated the long-term clinical efficacy of transanal irrigation (TAI) and its effect on the quality of life of spina bifida children and their caregivers. Setting: Republic of Korea. Method: Forty-four spina bifida pediatric patients with constipation, fecal incontinence or both, underwent a TAI program at our spina bifida clinic between December 2010 and October 2013. The children and their caregivers were evaluated using a self-administered questionnaire before TAI and at 3 months and 3 years after initiation of the program. Results: Successful treatment outcome was achieved in 38 (86.4%) children after a mean follow-up duration of 33 months (range, 30-36). The mean number of fecal incontinence episodes per week, the number of diaper changes and the total time for bowel care per day before the program decreased at the latest follow-up examination from 7.3 to 0.4 (Po0.001), 1.6 to 0.2 (Po0.001) and 29.2 to 19.4 min (P = 0.038), respectively. These results remained constant from short-term follow-up at 3 months to 3 years. Caregivers and children could go out more often (P = 0.002), and the emotional impact of bowel care on caregivers decreased (Po0.001). The reported mean overall satisfaction with TAI was 8/10. The common adverse effect during TAI was abdominal discomfort (60.5%). Conclusion: We observed a sustained significant improvement in defecation symptoms and quality of life for 3 years in spina bifida children who underwent continuous TAI. INTRODUCTIONSpina bifida (SB) is a congenital impairment of neural tube closure that occurs between 24 and 26 days of gestation 1 and affects the lower spinal cord with variable severity of neural symptoms that include neurogenic bladder and bowel dysfunction. 2 Appropriate management often achieves urinary continence, but bowel continence is a major concern for patients with SB. 3 More than 50% of children and adolescents with SB do not achieve full bowel continence; 4 bowel dysfunction is a major obstacle to independence, activity, social integration and good quality of life (QoL). 5 For some children with SB, bowel dysfunction is more distressing compared with their impaired motor function. 6 Several methods are used to deal with constipation and fecal incontinence in children with SB, including conservative or pharmacological management, transanal irrigation (TAI) and surgical approaches. Different laxatives have been used with varying success; however, when the internal sphincter is not fully functional, fecal incontinence or soiling occurs. 1 Therefore, a more aggressive management approach is needed for bowel continence in many cases. The Malone antegrade continence enema procedure is one of the most useful techniques for resolving fecal incontinence in SB children, but the downside of this procedure is the necessity for surgery. 6 Therefore, conservative treatment should be first administered, and the efficacy of TAI may predict the efficacy of Malone antegrade continence enema on bowel manageme...

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term outcome of transanal irrigation for children with spina bifida

et al. 2014

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“…4,31 The collection methods were interviews during follow-up visits 6,15,20,25,43 or telephone contacts 4,7,12,17,23,32,38 or both. 16,31,37,41 The follow-up period of SB patients after starting bowel management varied from 3, 15,19,20,22,23,41,42 over 12, 12,13,21,25,31 30 [16][17][18][27][28][29][30]34,39 and 60 months 24,32,33,35,36,40,43 to 120 months. 38,43 To explore different treatment modalities for bowel management in SB and their effectiveness the studies were grouped according to the treatment modality: conservative bowel management (16 studies), electrical stimulation (4 studies) and non-conservative (surgical) bowel management (17 studies).…”

Section: Resultsmentioning

confidence: 99%

“…26 All studies had a low grade of recommendation. 44 Clinical data were collected using questionnaires, 6,7,[12][13][14][15]17,19,[23][24][25]29,30,34,35,37,43 neurogenic bowel dysfunction scales, 20,26,45 QoL questionnaires 4,16,21,22,27,28,31,32,38,41 or child behavior checklists. 4,31 The collection methods were interviews during follow-up visits 6,15,20,25,43 or telephone contacts 4,7,12,17,23,32,38 or both.…”

Section: Resultsmentioning

confidence: 99%

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

et al. 2013

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A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients SV Velde, SV Biervliet, RD Bruyne and MV Winckel Study design: Systematic review. Objectives: To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness. Setting: International literature. Method: Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion. Results: Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n ¼ 509). In patients using RCE (n ¼ 190) an 80% continence rate was reached. Patients following surgical treatment (n ¼ 469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management. Conclusion: Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.

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“…This finding definitely supports stepwise and individually tailored bowel management programs by a multidisciplinary team starting in childhood. 12 It can be easily imagined that patients and their caregivers would appreciate the ease of MACE procedures and its high success rate compared with their previous bowel management strategy, particularly RCE. Patients who have not previously experienced problematic bowel management strategies seem to be not highly satisfied with MACE, regardless of their bowel condition.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

et al. 2013

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Study design: Retrospective chart review. Objective: To evaluate the clinical outcomes and factors influencing patient satisfaction with Malone antegrade continence enema (MACE) in patients with spina bifida. Setting: Japan. Methods: We performed retrospective analysis of 21 patients with spina bifida who underwent surgical creation of an MACE stoma. Clinical outcomes were evaluated by medical records, operative notes and mailed questionnaires. Patient satisfaction scores (SSs) were measured on a modified visual analog scale (VAS) from 1 to 10, and the factors influencing the SS were analyzed. Results: A 100% return rate for the mailed questionnaires was achieved. All patients underwent in situ appendicocecostomy with cecal plication. There was only one complication that required surgical revision. Regarding fecal continence, the overall success rate was 90%. Although 4 patients (19%) had severe irrigation pain and 4 patients (19%) found the washout time intolerably long, 18 (85%) of them were satisfied with the MACE procedure. Age at operation, experience of retrograde colonic enema (RCE), experience of stomal leakage, increased comfort at school or workplace and increased comfort at sleepovers significantly influenced SSs. Conclusion: MACE is a valuable option in achieving fecal continence in patients with spina bifida, with most patients being satisfied with the procedure. In our analysis, younger age at operation, previous experience of RCE, no stomal leakage and improvement of quality of life (enhanced comfort at school, workplace and sleepovers) significantly influenced the high satisfaction after MACE. Spinal Cord (2014) 52, 54-57; doi:10.1038/sc.2013.111; published online 1 October 2013Keywords: Malone antegrade continence enema; quality of life; patient satisfaction; fecal incontinence; spina bifida INTRODUCTIONThe Malone antegrade continence enema (MACE) procedure, which was first described in 1990 by Malone et al., 1 has revolutionized the management and improved the quality of life (QOL) of patients with spina bifida who suffer from refractory constipation and fecal incontinence. However, it has been reported in a long-term followup study that a considerable number of patients have ceased the MACE procedure. 2 To select good candidates for the MACE procedure among patients with spina bifida, it is important to evaluate not only the status of the bowel, but also the overall patient satisfaction after the procedure. The aim of this study was to evaluate the factors that influence overall satisfaction after the MACE procedure in patients with spina bifida.

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The effects of transanal irrigation as a stepwise bowel management program on the quality of life of children with spina bifida and their caregivers

Cited by 53 publications

References 24 publications

Long-term outcome of transanal irrigation for children with spina bifida

Long-term outcome of transanal irrigation for children with spina bifida

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

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