The Malone Antegrade Colonic Enema Enhances the Quality of Life in Children Undergoing Urological Incontinence Procedures

Abstract

The antegrade colonic enema procedure is easily performed and it should be considered for any child with significant physical limitations and/or refractory fecal incontinence before urological continence promoting procedures are done.

Malone antegrade continence enema (MACE) for fecal incontinence in imperforate anus improves quality of life

“…The MACE has been shown to significantly improve continence in varied patient populations, including children with fecal incontinence [6,13], adults with idiopathic constipation [5] and patients with myelomeningocele [7]. Likewise, we saw a significant improvement in continence in our patient population with 22 of 25 having staining less than once per week with no need for underwear changes.…”

“…Malone initially described frequent catheterizations, at least daily, to prevent this complication [15]. Other studies have seen similar results in stomal stenosis rates of 18-39% [6,7,16,17,19]. This complication appears to be decreased with frequent dilations/catheterizations and the inlay of skin at the cutaneous stomal anastomsosis.…”

“…Few studies have assessed the relationship to the patients' QOL following this procedure [7,13,14]. Others have studied both the complications related to the procedure including reoperation, stomal stenosis and volvulus, and the development of continence [5,6,[14][15][16][17][18].…”

“…The Malone Antegrade Continence Enema (MACE) procedure has been utilized in children and adults with fecal incontinence and constipation with a wide variety of primary diagnoses [2][3][4][5][6][7]. The MACE procedure has been adopted as an accepted treatment for children with imperforate anus (IA) and poor fecal continence.…”

Quality of Life and Continence in Patients with Spina Bifida

“…QoL is by its nature a holistic concept -an attempt to describe how well or poorly life works at a particular point in time. Many health professionals have assumed that incontinence control, achieved through rigorous medical or surgical management, may lead to better overall quality of life in people with SB [23]. To date, however, little has been known about the relationships between subjective quality of life in this group, and the urinary/faecal incontinence they experience and how it is treated.…”