Transanal irrigation in myelomeningocele children: an alternative, safe and valid approach for neurogenic constipation.
METHODS
A total of 60 children with myelomeningocele referred to Spina Bifida Center of Rome (31 boys and 29 girls; aged 8-17 years) were treated with transanal irrigation for three months.


OBJECTIVE
To investigate whether transanal irrigation is a valid and alternative approach for neurogenic constipation in children with myelomeningocele.


METHODS
A questionnaire on bowel disturbances, quality of life and side effects was completed before the beginning and at the termination of the study.


METHODS
Italy.


RESULTS
About 60% (36/60) of patients reported relief from constipation and 75% (12/16) for fecal incontinence. Wheelchair-bound and walking patients showed same high improvement of bowel habit. Mean (s.d.) scores before and after the study were: neurogenic bowel dysfunction total score: 17.5 (5.2) versus 8.5 (4.3) (P<0.001); digital stimulation of anorectum: 4.2 (2.8) versus 1.3 (2.5) (P<0.01); frequency of fecal incontinence: 5.5 (1.2) versus 1.3 (1.7) (P<0.01) and degree of general satisfaction: 3.0 (2.4) versus 7.7 (1.5) (P<0.001).We observed a reduction of urinary tract infections during the course of treatment: 14 total urinary tract infections (9 caused by Escherichia coli) before versus 6 (3) during treatment (P<0.01).


CONCLUSIONS
Transanal irrigation in children with myelomeningocele is an alternative and relatively safe approach for managing neurogenic constipation; in fact, it improves bowel disturbances, quality of life and seems to reduce the risk of urinary tract infections.
Ausili
E
E
Department of Paediatric Science, Catholic University Medical School, Rome, Italy. emanuele.ausili@tin.it
Focarelli
B
B
Tabacco
F
F
Murolo
D
D
Sigismondi
M
M
Gasbarrini
A
A
Rendeli
C
C
D000293:Adolescent; D001003:Anal Canal; D002648:Child; D003248:Constipation / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D011446:Prospective Studies; D011788:Quality of Life; D013223:Statistics as Topic; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D014563:Urodynamics / Q000502:physiology