The Importance of Bowel Management in the Treatment of Fecal and Urinary Incontinence, and Its Impact on the Quality of Life in Spina Bifida Children with Overactive Bladder and Detrusor Sphincter Dyssynergia.
Zoran I. Radojicic, PhD, MD1, Sasa S. Milivojevic, MD1, Jelena Milin Lazovic, MD2, Irena Koricanac, PsyD1, Sara Becanovic, PsyD1.
1University Childrens Hospital, Belgrade, Serbia, 2Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
BACKGROUND:
To examine the importance of bowel management in the treatment of fecal and urinary incontinence, and its impact on the quality of life in spina bifida children with overactive bladder and detrusor sphincter dyssynergia.
METHODS:
The research was carried out over the 2014-2017 period, during which 65 spina bifida children with overactive bladder and detrusor sphincter dyssynergia aged 4 to 16 were observed. The first group consisted of 34 patients on average 9.9 years old ± 3.5 SD, who were administered bowel management combined with anticholinergic medication therapy and CIC. The second group consisted of 31 patients on average 8.4 years old ± 3.5 SD, who were treated only with anticholinergic medication therapy and CIC. Bowel management included daily enema, laxative application and a special diet, with a view of treating constipation and fecal incontinence that was estimated on the basis of Roma III criteria, echosonographically determined transversal rectal diameter and encopresis frequency. The effects on urinary incontinence were estimated on the basis of the average dry interval between two CICs. Regarding the quality of life, we used a Kindle questionnaire for children and parents in order to determine the overall quality of life, but also the various aspects of the quality of children’s life (physical well-being, emotional well-being, self-confidence, family, friends, school, disease). The test score ranges from 0 to 100, where 0 is the lowest, and 100 the highest quality of life. The follow-up period of every patient was one year.
RESULTS:
There was no statistical significant difference regarding age, gender and baseline clinical features between two groups (p> 0.05). Before the administered treatment there was no statistically relevant difference in fecal incontinence frequency (p=0.619), the average dry interval (p=0.344), and quality of life between the groups (p=0.389). After one year treatment in the group that received bowel management 24 patients (70.6 %) gained full fecal continence, while in the group that did not receive bowel management 25 patients (80.6 %) had fecal incontinence (p< 0.001). In the group with bowel management the average dry interval between two CICs was 151.8 minutes ± 35.4SD, whereas in the group without bowel management the average dry interval was 96.3 minutes ± 46.4 SD (p< 0.001) . The overall quality of life in the bowel management group assessed by the children was 84.5± 8.9 SD, whereas the parents assessed it 88.9 ± 7.1 SD. In the group without bowel management the overall quality of life assessed by the children was 53.4 ± 12.5 SD, whereas the parents assessed it 55.4 ± 11.4 SD (p< 0.001). Moreover, in relation to all researched aspects of the quality of life there is a significant statistical difference both in the children’s and the parents’ opinion (p< 0.001).
CONCLUSIONS:
Administering bowel management considerably alleviates the symptoms of fecal and urinary incontinence but it also considerably improves the quality of life because of which it should form an integral part of treatment of spina bifida children with overactive bladder and detrusor sphincter dyssynergia.
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