Use of hydrocolonic sonography to monitor the effects of an enema: Pediatric...

Hydrocolonic sonography is used to avoid making a guess about enema amount and to avoid radiography

Hydrocolonic sonography allows evaluation of colonic motility and measurement of enema volume needed in fecal incontinence

In constipation, hydrocolonic sonography can visualize fecal impaction and evaluate colonic motility

A two-week defecation protocol is required prior to therapy to distinguish pseudo-incontinence with overflow from true fecal incontinence

Treatment always starts with intestinal purgation with polyethylene glycol (macrogol or movicol) to achieve a clean colon for evaluation

The bowel management program includes individually tailored enema, anal hygiene with showering after every enema, physiotherapy, defecation protocol monitoring, and psychiatric workup in many cases

Two pump systems can be used: an electric pump originally for stoma irrigation, or a hand pump made for people with spina bifida

A Foley catheter 24 French with 30 mL blockage is used, the same catheter system as used in Cincinnati

No air should be present in the colon during sonography because air makes it very difficult to monitor the abdomen with ultrasound

The catheter should be cleared of any air before insertion to ensure successful sonography

Hydrocolonic sonography is done in a special room in the presence of parents

With a successfully cleaned colon, ultrasound shows lovely movement allowing contact with every colonic cell

The adaptation period (time between filling the colon and first movement) can be measured

White spots on ultrasound represent air bubbles indicating the patient is not totally clean

The goal is to monitor whether the enema reaches the cecum and measure the volume needed to reach that point

If the enema volume reaches the cecum, it should be as effective at cleaning the whole colon as a Malone antegrade enema

In 20 adult patients (age 14+ years) with fecal incontinence after anorectal malformation surgery, all had constant social problems and soiling before treatment

After receiving tailored enemas guided by hydrocolonic sonography, only 2 of 20 patients still had problems with incontinence and soiling at 6 and 12 month follow-up

The two treatment failures were patients who did not follow the regime and decided not to do any more rectal irrigation