Transanal irrigation in myelomeningocele children: an alternative, safe and valid approach for neurogenic
E Ausili1, B Focarelli, F Tabacco
1Department of Paediatric Science, Catholic University Medical School, Rome, Italy. emanuele.ausili@tin.it
Insights
Transanal irrigation effectively manages neurogenic constipation in children with myelomeningocele, improving bowel function and quality of life. This safe alternative approach also appears to reduce urinary tract infections.
Area of Science:
- Pediatric Gastroenterology
- Urology
- Neurology
Background:
- Myelomeningocele often leads to neurogenic bowel dysfunction, significantly impacting children's quality of life.
- Current management strategies for neurogenic constipation can be invasive or have limited efficacy.
Purpose of the Study:
- To evaluate transanal irrigation as a viable and alternative treatment for neurogenic constipation in pediatric myelomeningocele patients.
- To assess the impact of transanal irrigation on bowel disturbances, quality of life, and associated complications.
Main Methods:
- A prospective study involving 60 children (aged 8-17) with myelomeningocele treated with transanal irrigation for three months.
- Data collected via questionnaires assessing bowel function, quality of life, and side effects before and after treatment.
Main Results:
- Significant improvement in constipation (60%) and fecal incontinence (75%) was observed.
- Patients showed marked reductions in neurogenic bowel dysfunction scores (P<0.001) and fecal incontinence frequency (P<0.01).
- A significant decrease in urinary tract infections (P<0.01) and an increase in general satisfaction (P<0.001) were noted.
Conclusions:
- Transanal irrigation is a safe and effective alternative for managing neurogenic constipation in children with myelomeningocele.
- The treatment improves bowel function, enhances quality of life, and may reduce the incidence of urinary tract infections.
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) (P<0.001); digital stimulation of anorectum: 4.2 (2.8) versus 1.3 (2.5) (P<0.01); frequency of fecal incontinence: 5.5 (1.2) versus 1.3 (1.7) (P<0.01) and degree of general satisfaction: 3.0 (2.4) versus 7.7 (1.5) (P<0.001).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 (P<0.01).
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.
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