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: Spinal anomalies occur in 1 out of 2000 live births and are associated with a neurogenic bladder and bowel, which leads to fecal incontinence, constipation, and/or bladder dysfunction.
Objectives/Goal: The current review aims to report the recent updates in bowel management of children with spinal anomalies. This review is a part of a manuscript series on a bowel management program (BMP) for patients with a colorectal diagnosis (anorectal malformation, Hirschsprung disease, spinal anomaly, or functional constipation).
Methods/Design: We performed a literature review using the Medline/PubMed database, focusing on published research papers over the last 5 years. Thirty-three of the selected manuscripts and book chapters were included in this review. Search keywords were the following: bowel management, spina bifida, spinal lesion, spinal anomaly, tethered cord, constipation, soiling, fecal incontinence, enema, urinary incontinence, antegrade continence enema, and transanal irrigation.
Results: Most patients with spinal abnormalities have fecal and/or urinary incontinence (up to 87% and 92%, respectively) and require a collaborative approach with urologists. The patients have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on a spinal MRI, the potential for bowel control in these children depends on age, lesion type, and level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for medical management include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. 97% of patients with spinal anomalies are managed conservatively without fecal diversion. Those who fail conservative treatment are candidates for a stoma creation. 22-71% of patients achieve social continence dependent on the type and level of the lesion. BMP also decreases the frequency of urinary tract infections and improves urodynamic characteristics and urinary incontinence.
Conclusions: We report the updates in bowel management of patients with a spinal anomaly, focusing on the potential for continence, evaluation, and treatment of these children.
MeSH Keywords
bowel management/spina bifida/meningocele/tethered cord/constipation/fecal incontinence/enema/urinary incontinence/laxative
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State-of-the-Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies
Background: Spinal anomalies occur in 1 out of 2000 live births and are associated with a neurogenic bladder and bowel, which leads to fecal incontinence, constipation, and/or bladder dysfunction.
Objectives/Goal: The current review aims to report the recent updates in bowel management of children with spinal anomalies. This review is a part of a manuscript series on a bowel management program (BMP) for patients with a colorectal diagnosis (anorectal malformation, Hirschsprung disease, spinal anomaly, or functional constipation).
Methods/Design: We performed a literature review using the Medline/PubMed database, focusing on published research papers over the last 5 years. Thirty-three of the selected manuscripts and book chapters were included in this review. Search keywords were the following: bowel management, spina bifida, spinal lesion, spinal anomaly, tethered cord, constipation, soiling, fecal incontinence, enema, urinary incontinence, antegrade continence enema, and transanal irrigation.
Results: Most patients with spinal abnormalities have fecal and/or urinary incontinence (up to 87% and 92%, respectively) and require a collaborative approach with urologists. The patients have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on a spinal MRI, the potential for bowel control in these children depends on age, lesion type, and level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for medical management include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. 97% of patients with spinal anomalies are managed conservatively without fecal diversion. Those who fail conservative treatment are candidates for a stoma creation. 22-71% of patients achieve social continence dependent on the type and level of the lesion. BMP also decreases the frequency of urinary tract infections and improves urodynamic characteristics and urinary incontinence.
Conclusions: We report the updates in bowel management of patients with a spinal anomaly, focusing on the potential for continence, evaluation, and treatment of these children.
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