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Retrograde continence enema in children with spina bifida: Not as effective as first thought
Author(s) -
King Sebastian K,
Stathopoulos Lefteris,
Pinnuck Loreto,
Wells Judy,
Hutson John,
Heloury Yves
Publication year - 2017
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.13408
Subject(s) - medicine , spina bifida , enema , fecal incontinence , constipation , quality of life (healthcare) , outpatient clinic , bowel management , anorectal manometry , pediatrics , physical therapy , surgery , nursing
Aim The aim of the study is to investigate the effectiveness of Peristeen retrograde continence enema ( RCE ) in the management of faecal incontinence in children with spina bifida. Methods We identified a homogenous group of spina bifida patients in whom RCE was initiated (Jan 2006–July 2013). Confidential assessments included (i) Fecal Incontinence Quality Of Life ( FIQOL ), (ii) St Marks Faecal Incontinence score, (iii) Cleveland Clinic Constipation score and (iv) Neurogenic Bowel Dysfunction score. Results Of 20 patients, 11 (mean age 14.5 ± 5.3 years) were male. Of 20 patients, nine were still using RCE (mean follow‐up 4.1 years). Three patients ceased RCE within 10 days, six after 4–12 months and two after 36–48 months. Reasons for cessation included balloon difficulties ( n = 4), procedure deemed too difficult ( n = 4) and pain ( n = 3). There were no differences between the groups in length of training time for technique, instillate fluid/volume used and time taken to perform RCE . There were no differences between the groups for quality of life, faecal incontinence or constipation scores. Conclusions We demonstrated a high rate of cessation with RCE in patients with spina bifida. This could not be explained by associated conditions, or by enema‐related parameters. One possible explanation is the lack of ongoing outpatient support for the children and their families.