Improving Bowel Management in Children With Spina Bifida

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.