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Intermediate and long-term outcomes of a bowel management program for children with severe constipation or fecal
Julie A Kilpatrick1, Sarah Zobell2, Elisabeth J Leeflang1
1University of Utah School of Medicine, Salt Lake City, UT.
Insights
A structured bowel management program (BMP) offers long-term success for children with severe constipation or fecal incontinence. Consistent outpatient support is key to achieving positive outcomes in pediatric bowel management.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Clinical Outcomes Research
Background:
- Severe constipation and fecal incontinence significantly impact children's quality of life.
- Effective long-term management strategies are crucial for pediatric patients with complex bowel issues.
Purpose of the Study:
- To evaluate the long-term clinical success rates of a structured Bowel Management Program (BMP) in children.
- To assess the efficacy of the BMP for severe constipation and fecal incontinence in pediatric patients.
Main Methods:
- A single-center retrospective chart review of 285 children (≤18 years) enrolled in a BMP between 2011-2017.
- Success defined as no accidents and <2 stool smears per week; follow-up at 12 and 24 months.
- Analysis included initial treatment regimens, adherence, and surgical interventions.
Main Results:
- Initial BMP success in 87% of adherent patients; 72% success at 12 months and 78% at 24 months.
- 33% of patients required surgery, including antegrade colonic enema (ACE) or diverting stoma.
- 44% required clinic contact for BMP adjustments, indicating the need for ongoing support.
Conclusions:
- Structured BMPs with accessible outpatient support lead to long-term success in treating pediatric severe constipation and fecal incontinence.
- Further multi-institutional studies are needed to identify predictors of BMP failure and non-adherence.
Purpose:
We sought to examine the long-term clinical success rates of a bowel management program (BMP) for children with severe constipation or fecal incontinence.
Methods:
A single center review was conducted of children (≤18 years) enrolled in a BMP and followed in a colorectal specialty clinic (2011-2017). All patients who completed an initial week of the BMP were included. Patients enrolled in a BMP after 2018 were excluded. Success was defined as no accidents and <2 stool smears per week.
Results:
A total of 285 patients were reviewed. BMP was initiated at a median age of 7 years (9 months-17 years). Primary diagnoses included functional constipation (112), anorectal malformation (ARM) (104), Hirschsprung Disease (HD) (41), rectal prolapse (14), spina bifida (6), fecal incontinence (3) and other (5; 4 sacral coccygeal teratomas and a GSW to the buttocks). Initial bowel regimen included large volume enema in 54% and high dose stimulant laxative in 46%. The initial Bowel Management Week (BMW) was successful in 233 (87% of adherent patients) patients with 17 (6%) non-adherent. One hundred twenty-two patients had follow-up at 12 months (72% success amongst adherent patients, 7% of patient non-adherent) and 98 patients had follow-up at 24 months (78% success amongst adherent patients, 10% of patients non-adherent). 21/154 (14%) patients started on enemas were later successfully transitioned to laxatives and 13/132 (10%) patients started on laxatives subsequently required enemas in order to stay clean. Clinic phone contact occurred outside of scheduled visits for adjustment to the BMP in 44% of patients. 33% of patients had surgery to aid bowel management (antegrade colonic enema (ACE) = 81, resection + ACE = 13, diverting stoma = 4). Median follow up was 2.5 years (5 weeks-7 years).
Conclusion:
Children who follow a structured BMP with readily available personnel to provide outpatient assistance can experience successful treatment of severe constipation or fecal incontinence long-term. A multi-institutional collaboration is necessary to identify factors which predict failure of a BMP and non-adherence.
Type Of Study:
Single-center retrospective chart review.
Level Of Evidence:
3.
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