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How to establish a successful bowel management programme in children: a tertiary paediatric centre experience
Ann M Costigan1, Stephanie Orr1, Abdulrahman E Alshafei1
1Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
Insights
This study shows that individualized bowel management programs, considering the child's condition and preferences, achieve high success rates in managing fecal incontinence. Key factors include underlying diagnosis, washout method, and caregiver involvement.
Area of Science:
- Pediatric Gastroenterology
- Clinical Outcomes Research
- Bowel Management Strategies
Background:
- Fecal incontinence management requires structured medical approaches.
- Individualized bowel management programs aim to improve continence and quality of life in children.
- Tertiary pediatric centers play a crucial role in developing and implementing these programs.
Purpose of the Study:
- To present the outcomes of an individualized bowel management program.
- To evaluate factors contributing to successful bowel management in pediatric patients.
- To assess the efficacy of a tertiary center's approach to fecal incontinence.
Main Methods:
- Retrospective review of 192 children attending a bowel management clinic over 5 years (2010-2015).
- Primary outcome: achieving a regular bowel pattern and social continence.
- Multiple linear regression analysis to identify factors influencing success.
Main Results:
- The program achieved a 93.7% success rate in managing fecal incontinence.
- Underlying conditions (e.g., spina bifida, Hirschsprung's disease) influenced the choice of washout method.
- Successful management was significantly associated with the underlying condition, washout medication, and administration method.
Conclusions:
- Individualized treatment protocols are essential, tailored to the child's specific condition and needs.
- A collaborative approach involving child, family, and healthcare providers is crucial for informed decision-making.
- Considering physical, social, and psychological factors enhances treatment effectiveness in pediatric bowel management.
Background:
Bowel management is a term used to describe a medical approach to the management of faecal incontinence.
Aims:
To present the outcomes of an individualised bowel management programme developed by a tertiary paediatric centre and evaluate contributory factors for successful bowel management in children.
Methods:
A retrospective review of children attending a bowel management clinic in a tertiary centre in Dublin, Ireland, over 5 years (2010-2015). The main outcome measure was the ability to achieve a regular bowel pattern and remain socially clean. Multiple linear regression analyses were used to determine the factors contributing to successful bowel management.
Results:
One hundred ninety-two children attended the clinic over 5 years. The median age at commencement of washouts was 7 years. Underlying diagnosis was spina bifida in 50%, imperforate anus in 17.7%, Hirschsprung's disease in 14.6%, idiopathic constipation in 7.8%, and other conditions in 9.9% of patients. Children with spina bifida and Hirschsprung's disease preferred Peristeen washouts, while those with imperforate anus and idiopathic constipation preferred Willis washouts (p < 0.001). Our programme was successful in 93.7% of cases. Regression analysis showed that the underlying condition (p < 0.001), washout medication (p = 0.016), and individuals administering washouts (p < 0.001) contributed to a successful bowel management programme.
Conclusion:
Treatment protocols should be individualised based on the underlying condition and outcomes. Decision-making must be cognisant of the physical, social, psychological, and developmental needs of the child and family. A partnership approach is advocated, which includes child and parent/carer preferences allowing them to make an informed decision.
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