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The Pediatric Bowel Management Clinic: initial results of a multidisciplinary approach to functional constipation in
1Department of Surgery, Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
Insights
A pediatric Bowel Management Clinic (BMC) using a multidisciplinary approach significantly improved functional constipation symptoms in children. The clinic also achieved high patient and parent satisfaction, demonstrating its effectiveness.
Area of Science:
- Pediatric Gastroenterology
- Clinical Management
- Child Health Outcomes
Background:
- Functional constipation is a common pediatric issue with multifactorial causes.
- Existing treatments are often insufficient, necessitating novel management strategies.
- A multidisciplinary approach is hypothesized to be effective for pediatric functional constipation.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary pediatric Bowel Management Clinic (BMC).
- To assess patient and family satisfaction with the multidisciplinary care model.
- To analyze short-term improvements in constipation-related symptoms.
Main Methods:
- Prospective data collection over 16 months in a newly established BMC.
- Quantitative analysis of clinical variables (stool consistency, frequency, pain, etc.).
- Qualitative analysis of psychosocial impact and patient/family satisfaction using the Measure of Processes of Care (MPOC) tool.
Main Results:
- Statistically significant improvements (P < .05) were observed in stool consistency, frequency, soiling, abdominal pain, rectal pain, and rectal bleeding.
- Qualitative data highlighted the substantial psychosocial burden of constipation on affected children and their families.
- The BMC achieved higher-than-average scores on the MPOC, indicating high satisfaction, except for the provision of information.
Conclusions:
- A multidisciplinary approach in a pediatric BMC leads to significant short-term improvements in functional constipation symptoms.
- The clinic model fosters high levels of patient and parent satisfaction with care.
- Further research is warranted to investigate the long-term efficacy of this multidisciplinary intervention.
Abstract:
The multifactorial nature of functional constipation in children suggests that a multidisciplinary management approach may be effective. The authors tested this hypothesis in a newly created pediatric Bowel Management Clinic (BMC). Detailed data were collected prospectively on all patients seen in the clinic over the first 16 months. Both quantitative and qualitative analyses were performed to describe the index population and to demonstrate the impact of the intervention. Satisfaction with care in the clinic was measured using the Measure of Processes of Care tool, then compared with a normative sample. One hundred fourteen patients, all previously treated unsuccessfully for constipation, were referred to a team comprised of a physician, nurse practitioner, nurse educator, dietitian, and psychosocial nurse specialist. The mean age was 5.4 years with equal gender distribution. Between the first and last visits recorded, several variables including stool consistency and frequency, soiling frequency, abdominal pain, rectal pain, and rectal bleeding all showed statistically significant (P < .05) improvement. Qualitative data analysis showed the significant psychosocial impact of constipation on patients and their families. In the Measures of Processes of Care questionnaire, scores for the BMC were higher than normal on all scales except in provision of information. A multidisciplinary approach to functional constipation leads to both patient and parent satisfaction and significant short-term improvement. Further studies will examine the long-term impact of the clinic.