title: A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness.
  
  
  METHODS
  International literature.
  
  
  METHODS
  Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion.
  
  
  RESULTS
  Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n=509). In patients using RCE (n=190) an 80% continence rate was reached. Patients following surgical treatment (n=469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management.
  
  
  CONCLUSIONS
  Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.
authors.affiliation: Department of Pediatric Gastroenterology, University Hospital, Ghent, Belgium.
authors.forename: S V
authors.initials: SV
authors.lastname: Velde
authors.forename: S V
authors.initials: SV
authors.lastname: Biervliet
authors.forename: R D
authors.initials: RD
authors.lastname: Bruyne
authors.forename: M V
authors.initials: MV
authors.lastname: Winckel
mesh_terms: D006801:Humans; D055496:Neurogenic Bowel / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016135:Spinal Dysraphism / Q000150:complications* / Q000628:therapy*