One-year impact of a bowel management program in patients with anorectal malformations (ARM) | 4 years | Single-institution Retrospective review of children with an ARM who completed one-week bowel management program (BMP) | 222 PATIENTS | 59.5% male | Median age 6.7 years | All patients started the program with daily soiling. | Bowel management type | 67.1% enemas (anterograde or retrograde) | 32.9% oral stimulant laxatives | At one year 70.4% of all patients were clean. | 73.6% on enemas | 62.1% on laxatives | Conclusion: Intensive BMP offers significant benefits to the fecal and urinary incontinence in patients with ARM after one year. | https://pubmed.ncbi.nlm.nih.gov/34092385/ | @StayCurrentApp | @StayCurrentMD | Source: Nationwide Children's Hospital, Columbus, OH | @EmTombash @emencisco @RodGerardo
One-year impact of a bowel management program in treating fecal incontinence in patients with anorectal malformations
Infographic · Nov 2021 · 1 min read
In brief
In brief
This retrospective study of 222 children with anorectal malformations demonstrates that an intensive bowel management program achieved 70% continence at one year, with sustained improvements in quality of life scores. Both enema-based (74% success) and laxative-based (62% success) approaches proved effective, with additional benefits observed in urinary symptoms.
- 70% of ARM patients achieved fecal continence at 1 year: 74% on enemas, 62% on laxatives with voluntary bowel movements
- Intensive bowel management significantly improved continence scores (Baylor 25→13) and quality of life metrics in children with ARM
- BMP benefits extended beyond fecal continence, improving urinary symptoms (Vancouver 11→6) and psychosocial functioning
- Sustained improvement at 1 year demonstrates long-term efficacy of structured bowel management in ARM population
- Both enema-based and laxative-based protocols can achieve continence; individualized approach based on patient response is key
Written by the GCMD Library team from the infographic.
A teal and yellow infographic divided into sections with icons including a calendar with checkmark and diverse patient avatars. The layout flows from study design at top, through bowel management methods in the middle (shown with percentage bars in yellow and white), to outcomes at bottom with large statistics and a yellow conclusion box.
Background: Many patients with anorectal malformations (ARM) need a bowel management program (BMP) to manage lifelong problems of fecal incontinence or severe constipation. We aimed to evaluate the sustainability of the results in such a program. Methods: A single-institution retrospective review was performed in children with ARM who attended our BMP (2015–2019). Standardized definitions and validated tools were used to assess fecal continence (Baylor Continence Scale), constipation (Cleveland Constipation Scoring System), urinary symptoms (Van- couver Symptoms Score), and the Pediatric Quality of Life (PedsQL) and health-related quality of life (HRQOL) at the start of BMP and 1-year after completion of the program.
Results: 222 patients with ARM at a median age of 6.7 (IQR, 4.9–10.1) years were identified. All (100%) soiled at intake with 149 (67.1%) patients being treated with rectal or antegrade enemas and 73 (32.9%) with oral laxatives. At 1 year 150 (70.4%) were clean, 72.7% were on enemas and 27.3% were on laxatives (p = 0.08). 109 out of 148 (73.6%) patients were clean on enemas. A further 41 out of 66 (62.1%) patients were continent on laxatives with voluntary bowel movements and clean. In the group that was clean, there was improvement in Baylor Continence Scale (25 vs. 13.0, p < 0.000000002), Vancouver (11 vs. 6, p = 0.0110) scores, and clinically relevant improvement in the total PedsQL HRQL (78–85) and the PedsQL HRQL physical function (86–92) and psychosocial domain (77–82). There was no improvement in Cleveland (10 vs. 9, p = 0.31) score.
Conclusion: An intensive BMP offers significant benefits in the treatment of fecal incontinence in ARM. It appears to also improve urinary incontinence and urinary voiding as well as the patient’s quality of life. These changes are sustainable over at least one year.