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Updated: Jun 26, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Pilot bowel management program at Mbarara Hospital, Uganda
Stephen Trinidad1,2, Felix Oyania3, Crispus Bingana4
1Cincinnati Children's Hospital Medical Center, Cincinnati, USA. Stephenmtrinidad01@gmail.com.
Insights
A pilot bowel management program (BMP) in Uganda successfully reduced involuntary bowel movements in children with Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Global Health
Background:
- Hirschsprung's disease (HD) and anorectal malformations (ARM) are congenital conditions often leading to chronic constipation and fecal incontinence in children.
- Effective bowel management programs (BMPs) are crucial for improving quality of life in affected children, but access is limited in low-income countries.
- This study piloted the first BMP in Uganda to address these challenges.
Purpose of the Study:
- To describe the implementation and outcomes of a pilot bowel management program (BMP) for children with Hirschsprung's disease (HD) and anorectal malformations (ARM) in Uganda.
- To evaluate the program's impact on involuntary bowel movements (IBMs) and healthcare provider confidence.
Main Methods:
- A pilot BMP was established in Uganda, involving training local healthcare staff (surgeons, nurses, physiotherapists) to manage patients with HD or ARM.
- Patients received initial clean-out procedures, followed by education for parents on performing daily enemas or irrigations.
- Patient outcomes, specifically rates of involuntary bowel movements (IBMs), and provider confidence were assessed using questionnaires before and after BMP implementation, with statistical comparison using Fischer's exact test.
Main Results:
- Twelve pediatric patients (median age 4.5 years, 10 male) participated, with 10 initially experiencing daily involuntary bowel movements (IBMs).
- Following BMP implementation, significant reductions in both daytime (p=0.0001) and nighttime (p=0.002) IBMs were observed.
- All participating healthcare staff reported increased confidence in managing these complex pediatric conditions.
Conclusions:
- The pilot BMP in Uganda demonstrated successful treatment of constipation and fecal incontinence in children with HD and ARM.
- This initiative highlights the feasibility of implementing BMPs in low-income countries, despite resource and follow-up challenges.
- Establishing local BMPs can significantly improve outcomes for children with these conditions in resource-limited settings.
Purpose:
Children with Hirschsprung's disease (HD) and anorectal malformations (ARM) may benefit from a bowel management program (BMP) to treat constipation and fecal incontinence. This study describes a pilot BMP in Uganda.
Methods:
Patients treated for HD or ARM were recruited for the BMP. Local staff underwent training and progressively took over decision-making. The rates of patient involuntary bowel movements (IBMs) and provider confidence were evaluated pre- and post-BMP with questionnaires. The results were compared with Fischer's exact test.
Results:
Ten staff-2 surgeons, 6 nurses and 2 physiotherapists-and 12 patients participated. Patient median age was 4.5 years (IQR 3-6.6) and ten were male. Ten reported at least daily IBMs prior to the BMP. All patients underwent a clean-out. The parents were then taught to perform daily enemas or irrigations. Specific regimens were determined by patient history and imaging and titrated throughout the BMP. There were differences in the rates of both daytime and nighttime IBMs before and after the BMP (p = 0.0001 and 0.002, respectively). All staff reported increased confidence.
Conclusions:
We describe the first BMP in Uganda. BMPs can successfully treat constipation and fecal incontinence in low-income countries, although there are challenges with resources and follow-up.
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