Presenter Status
Resident/Ph.D/Post graduate (> 1 month of dedicated research time)
Abstract Type
Research
Primary Mentor
Rebecca M. Rentea, MD, MS
Start Date
12-5-2023 11:30 AM
End Date
12-5-2023 1:30 PM
Presentation Type
Poster-Restricted Access
Description
Background: Functional constipation (FC) affects up to 32% of the pediatric population. This significantly impacts the quality of life, limiting routine activities and causing social distress. Some patients are referred to pediatric surgery units to manage their constipation and/or soiling. Half of FC patients managed by a gastroenterologist have persistent symptoms 5 years after referral, and 10% are still constipated at a 10-year follow-up and may require dedicated bowel management.
Objectives/Goal: Our goal is to present a review of bowel management protocols for patients with FC. The current review is a part of a manuscript series on a bowel management program for patients with a colorectal diagnosis (anorectal malformation, Hirschsprung disease, spinal anomaly, and FC).
Methods/Design: A literature review was performed utilizing the Medline/PubMed database focusing on the research studies published over the last 5 years. Search keywords included: bowel management, functional constipation, enema, laxatives, surgical treatment, colonic resection, balloon expulsion, constipation, and fecal incontinence.
Results: The first step of management of these children is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN), and, if AMAN shows an absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail medical treatment require further assessment of colonic motility and can be candidates for colonic resection. If needed, the type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test.
Conclusions: The current paper covers the recent updates in the bowel management of patients with FC, focusing on evaluation and medical and surgical management options for these children.
MeSH Keywords
bowel management/functional constipation/botox/botulinum toxin/fecal incontinence/enema/laxatives/constipation/colorectal surgery
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State-of-the-Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation
Background: Functional constipation (FC) affects up to 32% of the pediatric population. This significantly impacts the quality of life, limiting routine activities and causing social distress. Some patients are referred to pediatric surgery units to manage their constipation and/or soiling. Half of FC patients managed by a gastroenterologist have persistent symptoms 5 years after referral, and 10% are still constipated at a 10-year follow-up and may require dedicated bowel management.
Objectives/Goal: Our goal is to present a review of bowel management protocols for patients with FC. The current review is a part of a manuscript series on a bowel management program for patients with a colorectal diagnosis (anorectal malformation, Hirschsprung disease, spinal anomaly, and FC).
Methods/Design: A literature review was performed utilizing the Medline/PubMed database focusing on the research studies published over the last 5 years. Search keywords included: bowel management, functional constipation, enema, laxatives, surgical treatment, colonic resection, balloon expulsion, constipation, and fecal incontinence.
Results: The first step of management of these children is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN), and, if AMAN shows an absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail medical treatment require further assessment of colonic motility and can be candidates for colonic resection. If needed, the type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test.
Conclusions: The current paper covers the recent updates in the bowel management of patients with FC, focusing on evaluation and medical and surgical management options for these children.
Comments
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