Tap-water enema for children with myelomeningocele and neurogenic bowel dysfunction.
OBJECTIVE
To evaluate the outcome of transrectal irrigation (TRI) using clean tap water without salt in children with myelomeningocele and neurogenic bowel problems.


METHODS
40 children (21 boys and 19 girls; aged 10 mo to 11 y) with myelomeningocele and neurogenic bowel dysfunction were treated with TRI given by a stoma cone irrigation set daily or every second day. A questionnaire on the effects on faecal incontinence, constipation and self-management was completed by the parents, 4 mo-8 y (median 1.5 y) after start. Effects on rectal volume, anal sphincter pressure and plasma sodium were evaluated before and after the start of irrigation.


RESULTS
At follow-up, 35 children remained on TRI, four had received appendicostomy, while one defecated normally. For all children but five (35/40; 85%) the procedure worked satisfactorily, but a majority found the procedure very time consuming and only one child was able to perform it independently. All children were free of constipation; most (35/40) were also anal continent. Rectal volume and anal sphincter pressure improved, while plasma sodium values remained within the normal range.


CONCLUSIONS
Transrectal irrigation with tap water is a safe method to resolve constipation and faecal incontinence in children with myelomeningocele and neurogenic bowel dysfunction, but it does not help children to independence at the toilet.
Department of Molecular and Clinical Medicine, Division of Paediatrics, Faculty of Health Sciences, University Hospital, Linköping, Sweden. sven.mattsson@lio.se
Sven
S
Mattsson
Gunilla
G
Gladh
D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000097:blood / Q000209:etiology / Q000628:therapy*; D004733:Enema; D005242:Fecal Incontinence / Q000097:blood / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008591:Meningomyelocele / Q000097:blood / Q000150:complications*; D012648:Self Care; D012964:Sodium / Q000097:blood; D016896:Treatment Outcome; D014867:Water / Q000008:administration & dosage*
D014867:Water; D012964:Sodium