Use of the anal plug in the treatment of fecal incontinence in patients with meningomyelocele.
BACKGROUND
Children with meningomyelocele (MMC) commonly present with urinary and fecal incontinence. Despite bowel training and enemas, many still suffer from fecal soiling, which may cause skin irritation and malodor. Fear and embarrassment may cause some of these children to avoid partaking in social activities. The anal plug (AP), an anal tampon, has been developed to prevent fecal soiling. The purpose of this study was to evaluate the use of the AP in children with MMC with regard to reduction of fecal soiling and impact on social functioning.


METHODS
Twenty children and young adults with MMC, neurological level L(5) or proximal, participated in the study.


METHODS
Number of incidents of fecal soiling, degree of comfort of the accessory of choice, and impact of fecal soiling on social functioning were used as the main outcome measures for this study.


METHODS
Each participant kept a daily diary reporting on each of the outcome measures over the course of 5 weeks. The first week, prior to intervention with the AP, was used as the base control for each patient. Over three sessions, the use of the AP was explained and demonstrated, after which it was given to the participants to be used.


RESULTS
Seventy-five percent of the participants completed the study. There was a significant improvement in all outcome parameters following the intervention. The median number of weekly incidents of soiling dropped from 4 to 0 (p = .002). The median reported effect of fecal soiling on social integration before the use of the AP was found to be very bothersome, whereas during the use of the AP, it was barely bothersome (p = .004).


CONCLUSIONS
Use of the AP in children and young adults with MMC can prevent fecal soiling and promote "social continence."
Shoshan
Levana
L
Alyn Hospital, Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel.
Ben-Zvi
Dvora
D
Katz-Leurer
Michal
M
D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000293:Adolescent; D001003:Anal Canal; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D015400:Clinical Nursing Research; D005239:Fear; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D000297:Psychology, Adolescent; D002666:Psychology, Child; D012752:Shame; D012919:Social Behavior; D018709:Statistics, Nonparametric; D013630:Tampons, Surgical; D055815:Young Adult