Bowel training in spina bifida: importance of education, patient compliance, age, and anal reflexes.
Bowel incontinence is a major social impairment for 90% of patients with spina bifida. This study assess the bowel continence of children and young adults with spina bifida before and after a toileting intervention that emphasized patient/family education and a regular, consistently timed, reflex-triggered bowel evacuation. Bowel continence defined as one or fewer incontinent stools per month, rose from 13% (5/40) to 60% (24/40) following intervention. Twenty-four of the 35 initially incontinent patients were compliant. Seventy-nine percent (19/24) of the compliant subjects achieved continence whereas 0/11 of the noncompliant subjects achieved continence p < 0.0001). Presence of the bulbocavernosus (BC) and anocutaneous (AC) reflexes correlated significantly with achieving continence (either vs none p < .02, AC vs no AC p < .01). Instituting bowel training before age 7 correlated with improved outcomes by means of better compliance. Excluding noncompliant subjects, 83% (24/29) of the original sample of 40 patients satisfied our strict definition of bowel continence after this simple low technology intervention.
King
J C
JC
Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio.
Currie
D M
DM
Wright
E
E
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001003:Anal Canal / Q000294:innervation*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D012018:Reflex / Q000502:physiology*; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications*; D013997:Time Factors; D014039:Toilet Training; D016896:Treatment Outcome