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Published on: January 16, 2019
Neurogenic bowel and continence programs for the individual with spina bifida
1Clinical Nurse Specialist - Pediatrics, Texas Scottish Rite Hospital for Children, Developmental Disabilities, 2222 Welborn Street, Dallas, TX 75219, USA. Tel.: +1 214 559 7860; Fax: +1 214 559 7835;
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Managing neurogenic bowel in spina bifida requires a structured approach. Key strategies involve timed medications, regular toileting, and an interdisciplinary team for lifelong continence management.
Area of Science:
- Neuroscience
- Pediatric Gastroenterology
- Urology
Background:
- Neurogenic bowel in spina bifida presents unique challenges due to its developmental origins, differing from spinal cord injury-related neurogenic bowel.
- Limited research exists on the efficacy of continence programs for individuals with spina bifida.
Purpose of the Study:
- To outline a comprehensive management framework for neurogenic bowel in spina bifida.
- To highlight the importance of tailored continence programs for achieving bowel regularity and independence.
Main Methods:
- Utilizing a thirteen-item assessment framework including stool form, physiology, family history, diet, and medications.
- Implementing developmentally appropriate programs to encourage child participation.
- Employing timed medication and evacuation strategies, including oral medications, suppositories, or enemas.
Main Results:
- Successful management relies on precise timing of medications and bowel evacuation.
- An interdisciplinary team approach is crucial for sustained support.
- Dietary modifications and adaptive techniques are vital components.
Conclusions:
- Effective neurogenic bowel management in spina bifida necessitates a multifaceted, individualized approach.
- Early intervention and consistent application of continence strategies promote long-term independence.
- Collaboration between healthcare professionals, particularly dietitians and occupational therapists, optimizes outcomes.
Abstract:
The neurogenic bowel in the person with spina bifida has been difficult to manage. Current literature reveals very little research conducted on the outcome of continence programs in the person with spina bifida. It has different characteristics than the neurogenic bowel seen with spinal cord injury because it occurs during fetal development. Management of the neurogenic bowel to achieve continence is based upon thirteen assessment items that include stool form, individual physiologic parameters, family patterns, diet and medications. Programs are developmentally related to appropriately support the child's involvement. Continence strategies include the use of oral medication early in the day and timed sitting, suppositories or enemas later in the day at a time convenient to the family. The timing of the medications and evacuation is very important to the success. An interdisciplinary team is important in supporting the family as the child with spina bifida grows into an independent adult. The dietician and occupational therapist have invaluable insight into diet, fluids, adaptive aids and techniques that contribute to positive outcomes of the continence program.
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