A single-unit survey of bowel washout practice in children with neuropathic bowel
Authors: David Marshall, Emma Kelly, Laura Connolly, Alan Bailie, Nan Hill
Background
The majority of children with spina bifida require medical
assistance to eliminate socially disabling faecal
incontinence. Having recently surveyed units across the UK
and Ireland on their practice of bowel washouts (please see our
other submitted abstract), we wished to evaluate our own (largely
traditional) programme in more detail.
Materials and Methods
Patients receiving bowel washouts were captured from the
regional departmental database of 165 children (aged 0 - 18 years)
with spina bifida, and a database of others attending the
Continence Nurse Specialists. Parents were then contacted by
telephone, and/or the child's records reviewed, to complete a
questionnaire on their individual practice.
Results
Ten patients with spina bifida, and 6 with other "neuropathic"
conditions (anorectal malformation, Hirschsprung's disease and
chronic constipation) were identified. The mean age at which
bowel washouts were instituted was 11.0 (range 4 - 18) years, and
the mean interval since was 3.1 (range 0.3 - 8) years.
An initial washout volume of 500 ml was prescribed for all
children and, in some cases, this was titrated according to
effect. Salt was added to tap-water to approximate an
isotonic solution for all washouts. In the washout solution
twelve children required a laxative (sodium citrate in 11, and
bisacodyl in one), while four did not. Rectal washouts were all
administered via a balloon-catheter (Coloplast's Peristeen system
in 7 children), and most ACE washouts via a "gastrostomy"
button-device (7 children).
The most common side-effect was abdominal cramping, particularly
with bisacodyl or if the previous washout had been omitted.
The time spent on the toilet after administration of the washout
varied from 30 - 90 (mean = 53) minutes, with a tendency to be
longer in those with larger washout volumes. All children
were established on a daily washout, and then the interval between
washouts was gradually increased, unless incontinence returned: 13
children still required once-daily washouts, but three other
children remained socially clean with a washout every other day,
three-times per week, and twice per week respectively (the latter
on bisacodyl).
The chief difficulty for both children and parents was the time
commitment, although this was more than offset by the improved
quality of life.
Conclusions
Bowel washouts are a very effective treatment for neuropathic
bowel. Although our numbers are small, the increased tendency
to abdominal cramps seen with bisacodyl appears to be justified if
it reduces the weekly-time spent on the toilet, which is the main
complaint by users.
Dept. of Paediatric Surgery, Royal Belfast Hospital for Sick
Children, 180 Falls Road, BELFAST, N. Ireland, BT12 6BE,
UK
E-Mail: david.marshall@belfasttrust.hscni.net
