Treatment of fecal incontinence with a comprehensive bowel management program.
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.
Bischoff
Andrea
A
Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Levitt
Marc A
MA
Bauer
Cathy
C
Jackson
Lyndsey
L
Holder
Monica
M
Peña
Alberto
A
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
D005765:Gastrointestinal Agents