title: Treatment of fecal incontinence with a comprehensive bowel management program.
abstract: OBJECTIVE
  Many articles describe the antegrade continence enemas (ACEs), but few refer to a bowel management program. A successful ACE may not help a patient without such management. Valuable lessons were learned by implementation of bowel management in 495 fecally incontinent patients.
  
  
  METHODS
  We previously reported 201 patients. Thereafter, another 294 patients participated in our program. On the basis of a contrast enema and symptoms, they were divided as follows: (a) 220 constipated patients and (b) 74 patients with tendency toward diarrhea. Colonic stool was monitored with abdominal radiographs, modifying the management according to the patient's response and radiologic findings. For constipated patients, the emphasis was on using large enemas. For patients with tendency toward diarrhea, we used small enemas, a constipating diet, loperamide, and pectin. Diagnoses included anorectal malformation (223), Hirschsprung's (36), spina bifida (12), and miscellaneous (23).
  
  
  RESULTS
  The management was successful in 279 patients (95%)-higher in constipated patients (98%) and less successful in patients with tendency toward diarrhea (84%).
  
  
  CONCLUSIONS
  The key to a successful bowel management program rests in tailoring the type of enema, medication, and diet to the specific type of colon. The best way to determine the effect of an enema is with an abdominal film. The ACE procedures should be recommended only after successful bowel management.
authors.affiliation: Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bischoff
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
authors.forename: Cathy
authors.initials: C
authors.lastname: Bauer
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Jackson
authors.forename: Monica
authors.initials: M
authors.lastname: Holder
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004733:Enema; D005242:Fecal Incontinence / Q000178:diet therapy / Q000209:etiology / Q000628:therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents