The following is a summary of “Improving Bowel Management in Children With Spina Bifida,” published in the August 2023 issue of Pediatrics by Cohen, et al.

For a study, researchers sought to enhance bowel continence in children and adolescents with spina bifida (SB) to improve their quality of life and increase the likelihood of employment. To achieve this, a multidisciplinary clinic developed a bowel management assessment and follow-up protocol, and the study presented the outcomes using the quality-improvement methodology.

Bowel continence was defined as the absence of unplanned bowel movements. The protocol consisted of three main components: a standardized 4-item questionnaire to assess bowel continence and consistency; if continence was not achieved, an intervention plan was initiated, starting with oral medication (stimulant and/or osmotic laxatives) and/or suppositories (glycerin or bisacodyl), followed by escalation to trans-anal irrigation or continence surgery; and regular follow-up phone calls to monitor progress and adjust the plan as necessary. Descriptive statistics were used to summarize the results.

A total of 178 eligible patients in the SB clinic were screened, out of which 88 agreed to participate in the bowel management program. Among the patients who did not participate (90), a majority (76%; 68/90) were already achieving continence with their current bowel regimen. Among the children in the program, most (77%; 68/88) had a diagnosis of meningomyelocoele. After 1 year, the proportion of bowel accident-free patients improved to 46%, compared to the initial rate of 22% (P = 0.0007).

The implementation of a standardized bowel management protocol, with a focus on using suppositories and trans-anal irrigation to achieve social continence, along with regular telephone follow-ups, demonstrated a significant reduction in bowel incontinence among children and adolescents with SB.

Source: journals.lww.com/jpgn/Abstract/2023/08000/Improving_Bowel_Management_in_Children_With_Spina.12.aspx