title: Decision-making for a successful bowel continence program.
abstract: Bowel continence is one of the most difficult challenges for patients with spina bifida. Incontinence acts as a social stigma for children and a barrier for adults seeking employment. We present an algorithm for stepwise decision-making in construction of personalized continence programs for greater likelihood of success. The protocol contains 13 assessment points including; stool consistency, frequency and amount; mobility; level of paraplegia: diet; medication; anal/rectal canal tone; prior programs attempted; family routines; age; accessibility; and learning issues. Based on outcomes of these assessments, an individualized bowel program is constructed. The algorithm helps the practitioner and patient decide on components and indicators of a successful continence program. The recommended program might include timed toileting, suppository, continence enema, and ACE procedure, or a combination. Evaluation and patient education address adequate fluid/fiber, appropriate toileting equipment, and use of stool softeners/laxatives. Descriptions are available. Key elements in monitoring a continuing plan for continence include: the degree of constipation and its etiology; changing age; family availability for assistance until interdependence is optimal; wheelchair accessibility of the toilet; and ability to transfer to and from the toilet. Use of the algorithm allows for careful decision-making based on information from the patient and family. This has led to greater success in bowel continence in children with spina bifida.
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas 75219, USA.
authors.forename: S
authors.initials: S
authors.lastname: Leibold
authors.forename: E
authors.initials: E
authors.lastname: Ekmark
authors.forename: R C
authors.initials: RC
authors.lastname: Adams
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004733:Enema; D005242:Fecal Incontinence / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D007223:Infant; D016135:Spinal Dysraphism / Q000150:complications* / Q000534:rehabilitation; D013488:Suppositories; D014039:Toilet Training
chemical_list: D013488:Suppositories