688 Predictive factors for initiating trans anal irrigation in children with intractable constipation and faecal incontinence without neurogenic bowel dysfunction

Abstract

<h3>Aims</h3> Constipation and faecal incontinence is a common distressing symptom affecting about 3% of the childhood population.¹. Trans Anal Irrigation (TAI) was first introduced to paediatric practice in 1987 to treat children with neurogenic bowel dysfunction but has now become established practice for children with functional constipation and faecal incontinence.² As part of a quality improvement programme on the management of childhood constipation we sought to determine the predictive factors for initiation of TAI in children with intractable constipation and faecal incontinence without neurogenic bowel dysfunction. <h3>Methods</h3> We reviewed the records of children who were referred to a dedicated weekly consultant delivered community based multi-disciplinary clinic for severely constipated and encopretic children. Interventions to manage this condition were provided as appropriate for each child by the MDT team and they were reviewed as frequently as their clinical needs demanded by a consultant and a paediatric nurse. Demographic details, clinical information on constipation and faecal incontinence and the range of interventions given to each child were recorded in a customised database. Children and their carers fed back their progress weekly via a secure online customised database Qualtrics XM^©. We analysed the data from the clinical and demographic details of the children who were referred to the service to identify any predictive factors for initiating trans-anal irrigation. We used descriptive and statistical methods to analyse our data. <h3>Results</h3> 80 children (M:53) were referred to the dedicated community based multi-disciplinary PURA clinic for constipated children at The Hillingdon Hospitals NHS Foundation Trust. The average age was 10.2 yr (range 1-18 years). 44 (55%)children had recorded Cleveland Constipation (CC) and St Marks (SM) incontinence scores. 25 (M:16) children received trans-anal irrigation as part of the interventions to improve their condition. Children who received TAI had higher scores than those who did not: 15.9±5.9 vs 14.1±4.8 for CC (p&lt;0.17) and 16.7±4.9 vs 13.4±5.3 for SM (p&lt;0.02). Amongst those who received TAI, boys had much higher scores than girls 17.8±5.8 vs 13.4±4.5 CC and 17.4±4.8 vs 15±5.6 for SM scores. 16 (64%) of children who received TAI were diagnosed with learning difficulties. Of these 13 (81.2%) were boys. There was no difference in the proportion of male versus female children who received trans-anal irrigation in the cohort X^2:: p &lt; 0.4. However, there was a significant difference in the proportion of male children with learning difficulties compared with female children who received trans-anal irrigation to manage their symptoms. X²: p&lt;0.04. <h3>Conclusion</h3> Learning difficulties in male children with severe constipation and faecal incontinence is a significant predictive factor for initiating trans-anal irrigation as part of a suite of management interventions to improve this condition. <h3>References</h3> van den Berg MM, Benninga MA et al; Epidemiology of childhood constipation a systematic review Am J Gastroenterol 2006: 101 2401-9. Mosiello G, Marshall D et al; Consensus review of best practice for trans-anal irrigation in children JPGN 64:3 343-352.