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Published on: January 7, 2019
Long-term outcome of transanal irrigation for children with spina bifida
E K Choi1, S W Han2, S H Shin1
1Bladder-Urethra Rehabilitation Clinic, Department of Pediatric Urology, Severance Children's Hospital, Yonsei University Health System, Seoul, Republic of Korea.
Insights
Transanal irrigation (TAI) significantly improved bowel symptoms and quality of life for children with spina bifida over three years. This treatment offers sustained benefits for pediatric patients and their caregivers.
Area of Science:
- Pediatric Gastroenterology
- Neurogenic Bowel Dysfunction
- Quality of Life Studies
Background:
- Spina bifida often leads to neurogenic bowel dysfunction, causing significant challenges like constipation and fecal incontinence.
- Management of bowel issues in spina bifida impacts children's daily lives and caregiver burden.
Purpose of the Study:
- To evaluate the long-term clinical efficacy of transanal irrigation (TAI) in pediatric spina bifida patients.
- To assess the impact of TAI on the quality of life for both children with spina bifida and their caregivers.
Main Methods:
- A prospective study involving 44 pediatric patients with spina bifida and bowel dysfunction.
- Patients underwent a TAI program, with evaluations conducted at baseline, 3 months, and 3 years using self-administered questionnaires.
Main Results:
- Successful treatment outcomes were observed in 86.4% of children after a mean follow-up of 33 months.
- Significant reductions in fecal incontinence episodes, diaper changes, and bowel care time were noted, sustained over 3 years.
- Improvements in caregivers' ability to engage in social activities and reduced emotional burden were reported.
Conclusions:
- Continuous transanal irrigation (TAI) provides sustained, significant improvements in defecation symptoms for children with spina bifida.
- TAI enhances the quality of life for pediatric patients and alleviates caregiver burden over a 3-year period.
Study Design:
Experimental, prospective study.
Objectives:
We evaluated the long-term clinical efficacy of transanal irrigation (TAI) and its effect on the quality of life of spina bifida children and their caregivers.
Setting:
Republic of Korea.
Method:
Forty-four spina bifida pediatric patients with constipation, fecal incontinence or both, underwent a TAI program at our spina bifida clinic between December 2010 and October 2013. The children and their caregivers were evaluated using a self-administered questionnaire before TAI and at 3 months and 3 years after initiation of the program.
Results:
Successful treatment outcome was achieved in 38 (86.4%) children after a mean follow-up duration of 33 months (range, 30-36). The mean number of fecal incontinence episodes per week, the number of diaper changes and the total time for bowel care per day before the program decreased at the latest follow-up examination from 7.3 to 0.4 (P<0.001), 1.6 to 0.2 (P<0.001) and 29.2 to 19.4 min (P=0.038), respectively. These results remained constant from short-term follow-up at 3 months to 3 years. Caregivers and children could go out more often (P=0.002), and the emotional impact of bowel care on caregivers decreased (P<0.001). The reported mean overall satisfaction with TAI was 8/10. The common adverse effect during TAI was abdominal discomfort (60.5%).
Conclusion:
We observed a sustained significant improvement in defecation symptoms and quality of life for 3 years in spina bifida children who underwent continuous TAI.
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