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Bowel Management
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
Patients with a diagnosis of HD or an ARM who are not doing well with stooling after surgical repair will benefit from a Bowel Management Plan (BMP) to optimize medical management of their constipation or soiling. Likewise, those with fecal incontinence of a spinal or pelvic etiology (spina bifida, Sacrococcygeal teratoma) can also benefit. There are two main options for bowel management, either medical or mechanical treatment (Figure 15.2).
Bowel management
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Michael D. Rollins, Onnalisa Nash
Bowel management may take many different forms depending on the clinical setting and available resources. Also, the utility of routine abdominal radiographs to assess stool burden has been debated. However, the patient populations previously mentioned are unique and require more intense involvement by the provider. We also feel that routine abdominal radiographs are necessary in these populations to ensure effective emptying of the colon and rectum in order to avoid complications from severe constipation and fecal impaction such as the development of a megarectum and sigmoid. Follow-up is critical as many patients require frequent minor adjustments to their regimen in order to remain clean. The bowel management strategy described next is used at several specialty centers that have many resources but serves as a guide to any provider caring for patients in need of bowel management.
General guidelines for bowel management
Published in Onnalisa Nash, Julie M. Choueiki, Marc A. Levitt, Fecal Incontinence and Constipation in Children, 2019
Bowel management is an outpatient program used to treat fecal incontinence. The clinician selects an appropriate treatment modality, either oral stimulant laxatives or a mechanical program (once daily rectal or antegrade enema). The therapy is adjusted throughout the course of a devoted week according to the patient report and daily abdominal radiograph findings. Whether using an oral stimulant laxative or rectal enema washout, the goal of treatment in both cases is to stimulate a daily bowel movement and empty the colon. The child should then not have another bowel movement or soiling for 24 hours until the next treatment and thereby will be clean and able to wear normal underwear.
Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Sevda Demir Ture, Guven Ozkaya, Koncuy Sivrioglu
Early detection of severe NBD is a clinical priority. One study found that effective bowel evacuation could not be achieved with simple bowel management methods in approximately one-third of individuals with chronic SCI.31 Another study found that severe NBD is a significant predictor of dissatisfaction with bowel management.23 In both these studies, the authors emphasized that early detection and evaluation of individuals with severe NBD who are not responsive to simple treatment methods will provide crucial information and facilitate timely consideration of complex treatments, such as surgery.23,31 Another potential concern is that some individuals with SCI tend to view NBD as unmanageable and consequently do not seek medical advice.5 Although the relationship between NBD and injury-related variables has been examined extensively, factors associated with severe NBD have received less attention.21,23,27 Complete and high-level injuries and a longer duration of injury (≥10 years) have been shown to increase the likelihood of developing severe NBD.21,23 However, a recent study has not found such an association.27
Botulinum toxin type-A infiltration of the external anal sphincter to treat outlet constipation in motor incomplete spinal cord injury: pilot cohort study
Published in Scandinavian Journal of Gastroenterology, 2021
Margarita Vallès, Sergiu Albu, Hatice Kumru, Fermín Mearin
Spinal cord injury (SCI) is a first-magnitude medical, social and economic problem. It mainly affects young people, which may determine persistent disability and health-related problems, impairing quality of life [1,2]. Restoring bowel and bladder function, along with motor recover, emerge as priorities for individuals with SCI [3]. Neurogenic bowel is a major physical and psychological problem for persons with SCI, as changes in bowel motility and sphincter control, along with impaired mobility and hand dexterity, make bowel management a major life-limiting problem. However, bowel dysfunction treatment in patients with SCI has changed little since rehabilitation treatments were established by L. Guttmann in the mid-twentieth century [4]. Most treatments of neurogenic bowel consist of a regular routine, diet, sufficient intake of fluids, physical activity and use of laxatives. Different defecatory methods (including mechanical rectal stimulation, chemical rectal stimulation with suppositories, manual defecation, and attempted defecatory manoeuvres) are also advised, in order to achieve a predictable defecation within a reasonable time and to reduce or eliminate fecal incontinence episodes [5–7]. However, its design and modifications rely on an empirical approach, as no studies exist to demonstrate whether or not the various guidelines are effective [6].
The role of diet in multiple sclerosis: A review
Published in Nutritional Neuroscience, 2018
Sabrina Esposito, Simona Bonavita, Maddalena Sparaco, Antonio Gallo, Gioacchino Tedeschi
Up to 70% of MS patients complain about bowel dysfunctions (constipation and/or fecal incontinence) with discomfort and debilitating effects on their quality of life.127 In addition to neurological reasons, unbalanced diet, decreased food/water intake, impaired mobility, and adverse effects of the drugs, concur to their pathogenesis.128 Bowel management is mainly empirical and, despite limited evidence,129 some lifestyle recommendations may be drawn: a high-fiber diet (a gradual increase until reaching 25–30 g per day, through wheat bran and bran cereals, whole grain foods, fruits and vegetables), high fluid intake (approximately two liters daily), and regular bowel movement may be advantageous.127 Constipation and encopresis may also contribute to the development of urologic dysfunctions, experienced by up to 90% of MS patients,130 especially overactive bladder symptoms131 and recurrent urinary tract infections (UTIs).132 A full rectum may indeed displace the bladder leading to incomplete voiding133 and to subsequent UTIs; on the other hand, encopresis may favor urinary tract colonization leading to UTIs, exacerbation of bladder instability, and enuresis. UTIs have also been related to an increased risk in relapses.134 Nutritional attempts to prevent their onset have shown limited effectiveness, although no definite conclusions can be drawn. Small studies135,136 failed to show significant benefits of probiotics and cranberry juice – compared with placebo – in preventing UTIs. On the other hand, it is advisable to ensure bowel regularity and a proper water supply.