LAUSR

OBJECTIVES In individuals with spina bifida (SB), bowel incontinence is associated with lower quality of life and lower likelihood of employment. In an effort to maximize bowel continence in children and adolescents, we created a bowel management assessment and follow up protocol in a multi-disciplinary clinic. Here we report the results of this protocol using quality-improvement methodology. METHODS Continence was defined as no unplanned bowel movements. Our protocol involved:1) a standardized 4-item questionnaire about bowel continence and consistency; 2) If the patient was not achieving continence, an intervention starting with oral medication (stimulant and/or osmotic laxatives), and/or suppositories (glycerin or bisacodyl) followed by an escalation to trans-anal irrigation, or continence surgery; and 3) follow up phone calls at regular intervals to monitor progress and make changes as needed. Quality improvement methodology was employed. Results are summarized with descriptive statistics. RESULTS We screened 178 eligible patients in the SB clinic. Eighty-eight agreed to participate in the bowel management program. Of those who did not participate, the majority (68/90, 76%) were already achieving continence with their bowel regimen. Of children in the program, most (68/88, 77%) had a diagnosis of meningomyelocoele. At 1 year, the proportion of patients who were bowel accident free improved to 46% (vs 22% initially, p=0.0007). CONCLUSIONS A standardized bowel management protocol, primarily the use of suppositories and trans-anal irrigation to achieve social continence, as well as frequent telephone follow up, can reduce bowel incontinence in children and adolescents with SB.