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Improving Bowel Management in Children With Spina Bifida.

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A new bowel management protocol significantly improved bowel continence in children with spina bifida (SB). This multidisciplinary approach, using interventions like suppositories and irrigation, led to more children achieving social continence.

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Area of Science:

  • Pediatric Urology
  • Gastroenterology
  • Quality Improvement Science

Background:

  • Bowel incontinence significantly impacts quality of life and employment in individuals with spina bifida (SB).
  • Effective bowel management is crucial for maximizing independence and well-being in pediatric SB patients.

Purpose of the Study:

  • To implement and evaluate a multidisciplinary bowel management protocol for children and adolescents with SB.
  • To assess the effectiveness of the protocol in improving bowel continence rates.

Main Methods:

  • A standardized 4-item questionnaire assessed bowel continence and consistency.
  • Interventions included oral medications, suppositories, trans-anal irrigation, or surgery, based on patient needs.
  • Regular follow-up phone calls monitored progress and facilitated protocol adjustments.

Main Results:

  • Of 88 participants in the program, 77% had meningomyelocoele.
  • At 1 year, bowel continence improved to 46% from an initial 22% (P = 0.0007).
  • The majority of non-participants (76%) were already continent with their existing regimens.

Conclusions:

  • A standardized bowel management protocol, incorporating suppositories and trans-anal irrigation, effectively reduces bowel incontinence in pediatric SB.
  • Frequent telephone follow-up is a key component in achieving social continence.
  • This quality improvement initiative demonstrates a successful strategy for enhancing bowel management in SB.