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Predictors of successful transitions in a bowel management program
Anastasia M Kahan1, Sarah Zobell2, Lija Mammen1
1University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, USA.
Journal of Pediatric Surgery
|January 31, 2026
Summary
Approximately half of patients in bowel management programs (BMPs) transitioned to less invasive treatments within two years. Functional constipation cases showed earlier downgrades, supporting BMP effectiveness.
Area of Science:
- Pediatric Gastroenterology
- Bowel Management
- Clinical Outcomes
Background:
- Bowel management programs (BMPs) effectively treat severe constipation and encopresis.
- Evaluating treatment de-escalation in BMPs is crucial for optimizing patient care.
- Identifying predictors for downgrading treatment can improve management strategies.
Purpose of the Study:
- To assess the transition rate from more invasive to less invasive treatments within a BMP.
- To identify clinical characteristics associated with successful downgrading of treatment over time.
Main Methods:
- Retrospective analysis of 98 patients in a BMP (2020-2024).
- Follow-up data collected at 6, 12, 18, and 24 months.
- Downgrade defined as enema to laxative or laxative to no medication; success <2 stool smears/week. Multivariate Cox regression used.
Main Results:
- 49% of patients (48/98) downgraded treatment at a median follow-up of 12.9 months.
- Median time to downgrade was 6.2 months.
- Most common diagnoses: functional constipation (74%), Hirschsprung disease (16%). 62% initiated on enemas.
Conclusions:
- Nearly half of pediatric patients on BMPs can transition to less invasive therapies within two years.
- Earlier downgrades were observed in patients with functional constipation.
- Structured BMPs are effective, and findings can guide counseling on treatment de-escalation.
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