Achieving fecal continence in patients with spina bifida: a descriptive cohort study.
OBJECTIVE
Fecal incontinence is a major problem in patients with myelomeningocele. We evaluate the results of a stratified approach aimed at obtaining fecal pseudo-continence in patients with myelomeningocele.


METHODS
We conducted a cross-sectional descriptive study of last file data in 80 patients 5 to 18 years old with myelomeningocele followed at our center. Beginning at birth patients with myelomeningocele were seen at least annually by the pediatric gastroenterologist, a member of the multidisciplinary "spina team." Constipation was treated with diet and osmotic laxatives. Starting at age 5 years, treatment was targeted at achieving pseudo-continence. A toilet training scheme was started, associated with induced defecation by digital stimulation. Retrograde tap water enemas were used in patients with unsatisfactory results. If retrograde enemas were unsuccessful, an antegrade continence enema procedure was proposed. For children unable to sit on a toilet regular manual evacuation of stools was advised.


RESULTS
Eight of the 80 patients were fecal continent. Pseudo-continence was achieved in 50 of the 72 incontinent patients (69%), including 5 of 5 following only a strict toilet scheme, 21 of 24 (87.5%) performing retrograde enemas, 16 of 20 (80%) performing orthograde enemas through an antegrade continence device and 8 of 10 performing regular manual evacuation of stools. In 4 of the 20 patients (20%) performing orthograde enemas complications led to closure of the antegrade continence device. Treatment failed and was stopped in 17 patients. Success of treatment was not related to level of spinal lesion or degree of mobility.


CONCLUSIONS
Fecal pseudo-continence was achieved in 58 of 80 patients (72.5%) with myelomeningocele.
Vande Velde
S
S
Deparment of Pediatric Gastroenterology and Surgery, University Hospital Ghent, Ghent, Belgium. Saskia.vandevelde@ugent.be
Van Biervliet
S
S
Van Renterghem
K
K
Van Laecke
E
E
Hoebeke
P
P
Van Winckel
M
M
D000293:Adolescent; D001003:Anal Canal; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003672:Defecation / Q000502:physiology; D051517:Digital Rectal Examination / Q000379:methods; D004733:Enema / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010812:Physical Stimulation / Q000379:methods; D012307:Risk Factors; D016135:Spinal Dysraphism / Q000150:complications* / Q000175:diagnosis