Science Alert: Bowel dysfunction – management strategies

Available treatment options for bowel dysfunction vary depending on symptoms, but generally when starting therapy, a conservative approach is recommended. However, as one study shows, there is a reduction in bowel function over time in persons with neurogenic bowel disorders.

This may indicate that trying different therapies is important for maintaining bowel function over time.

Transanal irrigation is a non-invasive way of resolving constipation caused by neurogenic damage. It is not a therapy suitable for everyone, but it is worth trying if standard bowel care such as laxatives and digital stimulation fail.

New research studies have investigated its use. For example, it seems to be able to reduce bowel symptoms when used in children. Also, in adult populations starting TAI, one study shows that the quality of the first training session is one contributor to success.

Ageing with neurogenic bowel dysfunction.

Author and Origin

Summary

A study of bowel function in a cohort with spinal cord injury (SCI). A validated questionnaire was answered by 109 persons with SCI on three occasions over a 19-year period.

Conclusions

Self-assessed severity of constipation and time taken to defecate increased, quality of life remained stable and bowel care management remained stable, although with a slight increase in stoma surgery.

Comments

Questionnaire study of an SCI cohort investigating change of bowel function over time.

Psychological maladjustment and quality of life in adolescents with constipation.

Author and Origin

Summary

An observational survey of 1697 adolescents (aged 13-18 years) which assesses the connection between psychological maladjustment and functional constipation.

Conclusions

Prevalence of constipation was 6.7%. A signi cant proportion of children with constipation suffer from psychological maladjustments.

Comments

Survey of adolescents assessing the connection between psychological maladjustment and functional constipation.

Pathophysiology and Therapeutic Options for Fecal Incontinence.

http://journals.lww.com/jcge/Abstract/2017/04000/Pathophysiology_and_Therapeutic_Options_for_Fecal.6.aspx

Author and Origin

Guillaume A, Salem AE, Garcia P, Chander Roland B. US

Summary

Review of pathophysiology and therapeutic options for fecal incontinence (FI).

Conclusions

FI can affect individuals of all ages and greatly impairs quality of life. However, most cases are readily treatable, although more advanced cases need complete physiological assessment.

Comments

Review of prevalence, pathophysiology and therapeutic options for fecal incontinence in the US.

Childhood constipation: recognition, management and the role of the nurse.

http://www.magonlinelibrary.com/doi/pdf/10.12968/bjon.2016.25.22.1231

Author and Origin

Schuster Bruce J, Schuster Bruce C, Short H, Paul SP. UK

Summary

Review of constipation in children, covering epidemiology, symptoms, causes, and management. Also discusses the role of nurses.

Conclusions

Constipation is a common chronic condition in children. Nurses play an important role in early identi cation and effective management.

Comments

Review of pediatric constipation, epidemiology, symptoms, causes, and management.

Prospective evaluation of Peristeen® transanal irrigation system with the validated neurogenic bowel dysfunction score sheet in the pediatric population.

https://www.ncbi.nlm.nih.gov/pubmed/26879474

Author and Origin

Kelly MS, Dorgalli C, McLorie G, Khoury AE. US

Summary

Prospective study of 24 children and young adults (ages 3-21) comparing pediatric neurogenic bowel symptom score (NBoDS) at start of transanal irrigation (TAI; Peristeen) and after 2 weeks, 2 months and 6 months.

Conclusions

There was a statistically signi cant decrease of NBoDS at 2 weeks, 2 months and 6 months. All patients still used TAI after 6 months.

Comments

Prospective pediatric study using NBoDS speci c for children and young adults. Using TAI therapy in children shows a reduction in NBoDS.

Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360644/

Author and Origin

Bildstein C, Melchior C, Gourcerol G, Boueyre E, Bridoux V, Vérin E, Leroi AM. France

Summary

Retrospective study of 108 patients using transanal irrigation (TAI), investigating compliance at 1, 3, 6 and 12 months. The study also investigated factors of success be- tween adopters and non-adopters of TAI.

Conclusions

Compliance with TAI after 1 year was 43%. A complicated rst training session was the only factor to predict non-compliance with TAI.

Comments

Retrospective study investigating factors that predict likely responders and non-responders to TAI.

Open access.

A simple morpho-functional evaluation leads to a high transanal irrigation success rate in neurogenic bowel management.

http://www.pelviperineology.org/december-2016/pdf/pelviperineology-december-2016-web.pdf#page=30

Author and Origin

Spinelli M, Rizzato L, Renard J, Fredani L Italy

Summary

Study evaluating a functional and physiological evaluation method of establishing whether patients are candidates for transanal irrigation (TAI). The study included 100 patients with spinal cord injury, bowel evacuation dif culties, and a history of urinary tract infections (UTIs).

Conclusions

There was a signi cant decrease in UTIs after 6 months of using TAI. 88% of the patients still used TAI after 6 months.

Comments

Study presenting an evaluation method for the introduction of TAI.

This blog post is an extract of the Science Alert from April 2017 (76070-USX-1704)