Transanal irrigation in myelomeningocele children: an alternative, safe and valid approach for neurogenic constipation

Abstract

Study design: A total of 60 children with myelomeningocele referred to Spina Bifida Center of Rome (31 boys and 29 girls; aged 8-17 years) were treated with transanal irrigation for three months. Objective: To investigate whether transanal irrigation is a valid and alternative approach for neurogenic constipation in children with myelomeningocele. Methods: A questionnaire on bowel disturbances, quality of life and side effects was completed before the beginning and at the termination of the study. Setting: Italy Results: About 60% (36/60) of patients reported relief from constipation and 75% (12/16) for fecal incontinence. Wheelchair-bound and walking patients showed same high improvement of bowel habit. Mean (s.d.) scores before and after the study were: neurogenic bowel dysfunction total score: 17.5 (5.2) versus 8.5 (4.3) (Po0.001); digital stimulation of anorectum: 4.2 (2.8) versus 1.3 (2.5) (Po0.01); frequency of fecal incontinence: 5.5 (1.2) versus 1.3 (1.7) (Po0.01) and degree of general satisfaction: 3.0 (2.4) versus 7.7 (1.5) (Po0.001).We observed a reduction of urinary tract infections during the course of treatment: 14 total urinary tract infections (9 caused by Escherichia coli) before versus 6 (3) during treatment (Po0.01) Conclusion: Transanal irrigation in children with myelomeningocele is an alternative and relatively safe approach for managing neurogenic constipation; in fact, it improves bowel disturbances, quality of life and seems to reduce the risk of urinary tract infections.

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

“…Some of the studies administered questionnaires to collect data on reported clinical symptoms, 4-9 Neurogenic Bowel Dysfunction Scale, 10,11 quality of life 5,10,11 and patient satisfaction Likert scales. 5,10,12 Only the Neurogenic Bowel Dysfunction Scale is a validated instrument (in adult patients), the other questionnaires used in the reported studies were locally developed and non-validated. There was a general lack of information within the papers on who completed the questionnaires.…”

“…There was a general lack of information within the papers on who completed the questionnaires. The majority of questionnaires appeared to be completed by parents either within the clinical setting as part of the child's normal health care follow-up [9][10][11] or over the telephone. 4,5,12,13 Several of the studies reported data collected retrospectively from medical case notes 6,13,14 or reported findings based on data without it being stated how data had been obtained.…”

“…6,[15][16][17][18] The follow-up of children after initiation of transanal irrigation varied widely both within and across the studies. Where detailed, follow-up and data collection occurred from 3 months, 10 4 months, 8,17 12 months, 4 33 months, 14 64 months 6 to 96 months. 8 Findings of the review This evidence-based narrative review aimed to explore how effective and acceptable transanal irrigation is within this population and the findings are discussed within these two sections.…”

“…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).…”