Independence does not come with the method--treatment of neurogenic bowel dysfunction in children with
Peter Wide1, Gunilla Glad Mattsson1, Peder Drott1
1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Insights
Antegrade colonic enemas (ACE) and transanal irrigation (TAI) are effective bowel management options for children with myelomeningocele (MMC). Parents reported higher satisfaction with ACE, while independent toileting improved quality of life for children regardless of the method used.
Area of Science:
- Pediatric Gastroenterology
- Neuro-Urology
- Quality of Life Research
Background:
- Myelomeningocele (MMC) often leads to bowel dysfunction, impacting children's quality of life.
- Effective bowel management is crucial for independence and well-being in children with MMC.
- Current bowel regimes include antegrade colonic enemas (ACE) and transanal irrigation (TAI).
Purpose of the Study:
- To compare the effectiveness of ACE and TAI in children with MMC.
- To evaluate patient and parent satisfaction with different bowel regimes.
- To assess the impact of bowel management on faecal incontinence, independence, and quality of life.
Main Methods:
- A questionnaire-based study involving 172 children (aged 7–16) with MMC across three Scandinavian centers.
- Inclusion of the Pediatric Quality of Life Inventory (PedsQL 4.0™) to measure health-related quality of life.
- Response rate of 62% from participants using either ACE or TAI.
Main Results:
- Parents reported significantly higher satisfaction with ACE (30% of participants) compared to TAI (47% of participants).
- Children and parents in the ACE group noted more complete bowel evacuation than the TAI group.
- No significant differences were observed in faecal incontinence or independent toileting between the two methods; however, children achieving independent bowel emptying reported higher quality of life.
Conclusions:
- Both TAI and ACE are effective but time-consuming bowel management strategies for children with MMC, often requiring assistance.
- ACE demonstrates higher parental satisfaction compared to TAI.
- Supporting children to achieve independent toileting is paramount for enhancing their quality of life, irrespective of the specific bowel management method employed.
Aim:
The aim was to evaluate and compare different bowel regimes with regard to satisfaction, faecal incontinence and independence, and the relationship to quality of life among children with myelomeningocele (MMC).
Methods:
A questionnaire, including the health-related quality of life instrument PedsQL 4.0™, was sent to all children aged seven to 16 years (n = 172) with MMC, treated at two centres in Sweden and one in Norway. The three centres cover a third of the population in the two countries. The response rate was 62%.
Results:
Parents of children (30%) using antegrade colonic enemas (ACE) reported higher satisfaction (p = 0.01) than the parents of those (47%) using transanal irrigation (TAI). The children reported no significant difference. Children and parents in the ACE group reported more complete evacuation of the bowels than the TAI group. No significant difference was found in faecal incontinence or independent toileting. The children (40%) who emptied their bowels independently reported a higher quality of life. Children using TAI or ACE spent around one hour on the toilet at every bowel emptying.
Conclusion:
TAI and ACE are effective treatments, but time-consuming and difficult to perform independently. Higher parental satisfaction is obtained with ACE. Irrespective of method the children who can use the toilet independently report a higher quality of life, which makes efforts to support independence valuable.
More Related Videos
07:41Video Imaging and Spatiotemporal Maps to Analyze Gastrointestinal Motility in Mice
Published on: February 3, 2016
09:44Functional Assessment of Intestinal Motility and Gut Wall Inflammation in Rodents: Analyses in a Standardized Model of Intestinal Manipulation
Published on: September 11, 2012
Related Concept Videos
01:26The Micturition Reflex
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:23Irritable Bowel Syndrome
01:20Gastrointestinal Motility Disorders
01:30Irritable Bowel Syndrome III: Medical and Nursing Management
01:17Irritable Bowel Syndrome I: Introduction
IBS is a chronic condition that can persist over a long period or recur frequently.
The pathogenesis of IBS involves a complex interplay of the following factors:
Altered...