Bowel Continence Research Articles

Colonic Manometry in Pediatric Patients with Spina Bifida: Results from a Retrospective Cohort Study

Background/Objectives: Patients with spina bifida (SB) commonly experience neurogenic bowel dysfunction, characterized by defecation-related symptoms. While anorectal dysfunction and slow transit constipation (STC) have been implicated, the role of colonic motility in SB remains unclear. This study aimed to evaluate colonic motility in SB patients with refractory bowel dysfunction. Methods: This retrospective cohort study included SB patients who failed the repeated optimization of a bowel regimen including stimulant laxatives and subsequently underwent anorectal manometry (ARM), colonic transit time (CTT) studies, or colonic manometry (CM). Diagnostic findings were analyzed alongside treatment outcomes. Results: A total of 13 patients with myelomeningocele were included; one declined further treatment, and 12 underwent treatment optimization, with four achieving bowel continence. Of the five patients who proceeded with advanced motility testing, two had abnormal ARM findings, one of three had abnormal CTT results, and all five had normal CM findings. Conclusions: These findings suggest that anorectal dysfunction or STC may play a larger role in refractory bowel symptoms, while colonic motility appears to be preserved, and this highlights the importance of maximizing conservative therapies, particularly with stimulant laxatives, before pursuing invasive tests or surgical interventions for bowel dysfunction in this population.

P0386 Prevalence and Impact of Anorectal Disorders in IBD: Insights from a Romanian Tertiary Gastroenterology Center

Abstract Background Anorectal motility disorders profoundly affect the quality of life in patients with quiescent inflammatory bowel disease (IBD). Although faecal incontinence (FI) has a reported prevalence of up to 74%, its true extent is likely underestimated due to the stigma surrounding the condition. Fear of FI and challenges in accessing toilets remain significant concerns. This study evaluates the prevalence of these issues in Romanian tertiary care patients using the validated questionnaire International Consultation on Incontinence Questionnaire for Bowel Incontinence – IBD (ICIQ-IBD). Methods We surveyed 65 IBD patients aged over 18, admitted to our center, who were in remission but had previously experienced moderate to severe disease. Using the ICIQ-IBD questionnaire, we collected data on faecal incontinence, soiling, anal dyskinesia, their impact on quality of life, and demographic information. The analysis was conducted using Excel and Minitab. Results Of the 65 patients included in the study, 69% were male, with a median age of 40.82 ± 12.10 years. The majority were diagnosed with Crohn’s disease (65% CD, 35% UC). During remission, 22% of patients reported the need to rush to the toilet “always” or “most of the time,” compared to 40% during relapse, with a significant difference between disease phases (p = 0.02) but no differences based on gender or diagnosis. In relapse, 68% of patients had less than one minute to reach a toilet, compared to 32% in remission (p = 0.00). Soiling was reported by 49% of patients during active disease and 25% in remission (p = 0.004). Difficulty controlling liquid stools affected 62% of patients in relapse and 55% in remission, with no significant difference between disease states (p = 0.417). Emotional impact was reported by 72% of patients in relapse and 15% in remission, highlighting the psychosocial burden of bowel dysfunction in IBD. Conclusion Anorectal disorders significantly affect IBD patients’ quality of life, even during remission. Key symptoms, such as soiling and urgency, were more prevalent during relapse and strongly linked to emotional distress. These findings underscore the need for targeted management of anorectal symptoms in IBD care. References Norton, Christine et al. “Faecal incontinence in inflammatory bowel disease: associations and effect on quality of life.” Journal of Crohn’s & colitis vol. 7,8 (2013): e302-11. doi:10.1016/j.crohns.2012.11.004 Dibley, Lesley et al. “Development and initial validation of a disease-specific bowel continence questionnaire for inflammatory bowel disease patients: the ICIQ-IBD.” European journal of gastroenterology & hepatology vol. 28,2 (2016): 233-9. doi:10.1097/MEG.0000000000000513

Do We Have Sufficient Evidence to Derive Innovative Approaches to Assessing Unmet Need, Delivering Education on Bladder and Bowel Continence Health, and Providing a Better Environment for Joint Decision-Making? ICI-RS 2024.

Improved continence outcomes are reliant on identification of unmet need, education delivery, and shared decision-making. The evidence base on which to derive innovative approaches in these areas was unclear. A debate held at the International Consultation on Incontinence-Research Society meeting, held in Bristol in June 2024, considered ways to improve research requirements to advance these areas. Artificial intelligence solutions and digital approaches to healthcare are emerging at pace and offer possibilities to improve these three key areas but this must be driven by person-centered approaches. Care must be taken to avoid increasing inequality through digital exclusion and language barriers. Research questions are highlighted to derive innovation in these three key areas.

Assessment of long-term quality of life, bowel and voiding function outcomes in patients with anorectal malformation at a single UK centre.

Assess long-term quality of life (QoL), bowel and voiding function in anorectal malformation (ARM) paediatric patients. Retrospective review of ARM patients between 2007 and 2020 was performed. QoL (all patients), bowel and voiding function (> 5yo) were assessed using the paediatric quality of life inventory (PedsQL), paediatric incontinence and constipation score (PICS) and dysfunctional voiding scoring system (DVSS), respectively. There were 122 patients (49% female, 85 > 5yo) with ARM. Two had died, four refused, twenty-two were non-contactable, leaving ninety-four patients (65 > 5yo) included. Mean age was 89months (19-183), and follow-up was 86months (13-183).Patients had significantly poorer scores for QoL, bowel and voiding function compared to published healthy controls. 57% had poor bowel function, 32% had poor voiding function and 38% required 'ancillary aids' to facilitate function. Patients using 'ancillary aids' for voiding function had a significantly lower QoL (parent: 62 vs 77; p = 0.01, patient: 66 vs 79; p = 0.05).Bowel continence was worse in those with high vs low ARM (13 vs 20, p = 0.004) and timely vs delayed diagnosis (17 vs 24, p = 0.04). Patients with ARM have significantly worse QoL, bowel and voiding function than normal healthy controls. There is a need for long-term monitoring of function and further support for these children. III.

Centrally Distributed Adiposity as a Modifiable Risk Factor for Fecal Incontinence: United States Population-based Analysis

Fecal incontinence (FI) is highly prevalent with substantial impacts on quality of life and health care utilization. The impact of obesity on FI remains unclear, with differing conclusions using body mass index (BMI) as a risk factor. We aimed to determine the association between obesity and FI, and whether this relationship is dependent on the distribution of adiposity (waist circumference-to-height ratio [WHtR]). This was a population-based analysis of the National Health and Nutrition Examination Survey, including participants who responded to the bowel health survey in 2005 to 2010. FI was defined by the accidental bowel leakage of solid stool, liquid, or mucus at least once in the past month. Stepwise multivariable logistic regression models were constructed to assess risk factors for FI. A total of 7606 participants were included, with an overall FI prevalence of 9.2%. When stratified by quartiles of body measurements, FI was increasingly prevalent from the 1st to the 4th quartile for both WHtR (range, 5.3%-12.5%) and BMI (range, 7.1%-10.5%). WHtR was associated with FI and was a stronger predictor than BMI in all quartiles of body measurement. On multivariable analysis, WHtR remained a significant predictor of FI comparing the 4th with the 1st quartile of body measurements (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.11-2.80; P= .017), whereas BMI was not. A WHtR cutoff of >0.592 optimized the Youden index in prediction of FI in the overall sample. WHtR was independently associated with increased odds of FI in this nationally representative sample of United States adults, whereas BMI was not consistently correlated. This suggests bowel continence may depend more on how body mass is distributed.

Pediatric intensive bowel continence rehabilitation training: a retrospective study to evaluate feasibility, tolerance and effectiveness.

Pediatric continence dysfunction is not uncommon. It causes long-term disability, impairing quality of life, activities and relationships with pears and can affect until adulthood. A high-risk population are children with Hirschsprung's disease and congenital anorectal malformation. Conservative medical and surgical management of continence dysfunction in this population is deeply described, while the rehabilitation issues are still unexplored. Aim of this study is to preliminary verify the feasibility, tolerance and effectiveness of an intensive technological aided and individualized pelvic floor rehabilitation program for pediatric patients. This is a single-center, retrospective observational study. The assessment was performed by collecting demographic data, general and local physical examination and scoring assessment tools (Rintala Continence Score and Wexner Score). The study was conducted in the Rehabilitation Unit of the pediatric Giannina Gaslini Institute, a tertiary care pediatric hospital in Genoa (Italy) between September 2015 to August 2019. We enrolled 31 children; 25 male (80.6%) and six females (19%), aged between 5 and 14 years (mean age 9 years) at the beginning of the training. Twenty children (65.5%) had Hirschsprung's disease, and 11 children (34.5%) had a congenital anorectal malformation. The rehabilitation training program was customized on the compromised function, the anatomic characteristics, the child's age and compliance. The training was aimed at improving tone, strength, endurance of the pelvic floor, compliance and rectal sensitivity, and also the frequency of the bowel movements. All patients enrolled in the study underwent an intensive outpatient treatment lasted 5 days for children older than 7 years; 10 days for younger. The intensive rehabilitation treatment was followed by a continuous home training program. Twenty-nine children (96.8%) completed the training. A global improvement is observed in continence functioning in all the cohort at T1 (P<0.0001), maintained at T3 (P<0.0001) at both Rintala Continence Score and Wexner Score. No adverse effects have been referred. Our specific pediatric training program for pelvic floor rehabilitation is effective and safe for children with continence dysfunctions after pelvic surgery due to Hirschsprung's disease and anorectal malformations. The continence rehabilitation multimodal program should be integrated in the care of children with continence dysfunctions. It cooperates in the prevention of the long-term health global impairment and also in the reduction of social economic effort.

Cecostomy tubes improve bowel continence for pediatric patients with spina bifida: A retrospective analysis of outcomes from a single clinic.

Pediatric patients with spina bifida often experience neurogenic bowel dysfunction. Although cecostomy tubes could improve bowel continence, their effectiveness is not well established in this population. The aims of this study were to better understand the effectiveness of cecostomy tubes relative to other management strategies (between-subject) and to explore their effectiveness among patients who received these placements (within-subject). Retrospective analysis of data from pediatric patients enrolled in a national spina bifida patient registry (n = 297) at a single multidisciplinary clinic was performed, covering visits between January 2014 -December 2021. Linear and ordinal mixed effect models (fixed and random effects) tested the influence of cecostomy status (no placement vs placement) and time (visits) on bowel continence while controlling for demographic and condition-specific covariates. Patients with cecostomy tubes had higher bowel continence compared to patients without placements (B = 0.695, 95% CI [0.333, 1.050]; AOR = 2.043, p = .007). Patients with cecostomy tubes had higher bowel continence after their placements compared to before (B = 0.834, 95% CI [0.142, 1.540]; AOR = 3.259, p = 0.011). Results indicate cecostomy tubes are effective for improving bowel continence in this pediatric population. Future research is needed to conduct risk analyses and determine the clinical significance of these effects.

Long-Term Functional Outcomes and Multidisciplinary Management after Ileorectal Duhamel Pull-Through for Total Colonic Aganglionosis-20-Year Experience in a Tertiary Surgical Center.

Management of patients with total colonic aganglionosis (TCA) is challenging for pediatric surgeons. The purpose of this study was to review our institution's 20-year experience regarding long-term outcomes and multidisciplinary team management of these patients after an ileorectal Duhamel pull-through procedure. Retrospective review was conducted for all patients diagnosed with TCA in our tertiary institution. Data were collected on demographics, clinical presentation, complications, need for additional surgery, and long-term effects on bowel function. Of a total of 202 patients with Hirschsprung's disease, 13 were diagnosed with TCA (6.4%). Clinical presentation was variable. Eleven presented in neonatal period with distal bowel obstruction and two presented with constipation in early infancy. Ileorectal Duhamel pull-through was performed in all patients. Median follow-up was 13 years. Eleven are toilet trained, of whom five are fully continent. Six continue to have problems with bowel continence or constipation. One developed recurrent episode of Hirschsprung's associated enterocolitis. Two patients had stoma re-established. Patients experiencing difficulties in bowel function are jointly managed by a multidisciplinary team consisting of surgeons, gastroenterologists, pediatric psychologists, and clinical nurse specialists. TCA can be associated with significant long-term morbidity. Nearly half of the patients in this series have ongoing problems with bowel continence requiring a permanent stoma in some. Diligent follow-up coupled with inputs of a multidisciplinary team has greatly helped manage these complex patients in our institution.

Short and long-term outcomes in Hirschsprung disease: Are the syndrome-associated patients really doing worse?

Given the lack of data to help caregivers in the follow-up of Hirschsprung disease (HD), this study aimed to compare the functional outcomes of isolated Hirschsprung disease (I-HD) to syndrome-associated Hirschsprung disease (SA-HD) at 1, 3, 5, and 10 years. A retrospective chart review of patients diagnosed with HD between January 1990 and May 2021 at our pediatric center was performed to collect data on patient characteristics, investigations, and treatments. Ninety-five patients were identified, of whom 76 were included in the study. SA-HD is defined as a syndrome known to be associated with HD or cognitive impairment. Patient characteristics were comparable between groups (P > 0.05). There were 52 patients with I-HD and 24 with SA-HD. The patients median age was 9 days at diagnosis and 1.5 month at surgery. SA-HD patients became bowel continent at a significantly older age (mean age 8.43y vs 4.94 years, p=0.0471) and received more bowel continence medications. At 5y, SA-HD patients requiring ≥ 2 medications for bowel continence represented 54.5% vs. 11.1% of I-HD patients (p=0.009). Lastly, SA-HD patients had urinary incontinence at a significantly older age (p=0.0136, 5y). Clinicians should be aware that SA-HD patients are more prone to bladder dysfunction and became bowel continent at an older age than I-HD patients. They need more and prolonged bowel management medications, and other important complications need to be addressed in patient care. These results should prompt a longer follow-up period for these patients, especially in SA-HD.

Improving Bowel Management in Children With Spina Bifida.

In individuals with spina bifida (SB), bowel incontinence is associated with lower quality of life and lower likelihood of employment. In an effort to maximize bowel continence in children and adolescents, we created a bowel management assessment and follow-up protocol in a multidisciplinary clinic. Here we report the results of this protocol using quality-improvement methodology. Continence was defined as no unplanned bowel movements. Our protocol involved: (1) a standardized 4-item questionnaire about bowel continence and consistency; (2) if the patient was not achieving continence, an intervention starting with oral medication (stimulant and/or osmotic laxatives), and/or suppositories (glycerin or bisacodyl) followed by an escalation to trans-anal irrigation, or continence surgery; and (3) follow-up phone calls at regular intervals to monitor progress and make changes as needed. Results are summarized with descriptive statistics. We screened 178 eligible patients in the SB clinic. Eighty-eight agreed to participate in the bowel management program. Of those who did not participate, the majority (68/90, 76%) were already achieving continence with their bowel regimen. Of children in the program, most (68/88, 77%) had a diagnosis of meningomyelocoele. At 1 year, the proportion of patients who were bowel accident free improved to 46% (vs 22% initially, P = 0.0007). A standardized bowel management protocol, primarily the use of suppositories and trans-anal irrigation to achieve social continence, as well as frequent telephone follow-up, can reduce bowel incontinence in children and adolescents with SB.

Identification, assessment and treatment of urinary incontinence and bowel control issues.

Urinary incontinence and bowel control issues are prevalent within the general population and have significant adverse effects on peoples' daily lives and quality of life. This article examines the prevalence of urinary incontinence and bowel control issues and describes some of the more common types of issues. The author explains how to undertake a basic urinary and bowel continence assessment and outlines some of the treatment options, including lifestyle interventions and medicines.

Cloacal Malformation with Associated Urethral Atresia

Introduction Cloacal malformations comprise a heterogeneous group of anomalies that are considered the most complex anorectal malformations (ARMs) in females. Precise evaluation to identify the unique anatomy prior to reconstruction with collaboration between colorectal surgeons, urologists, and gynecologists is vital. Here, we present a rare anatomical variation in a patient with a cloacal malformation which affected operative and postoperative management. Case description A 6-year-old female with cloaca who underwent colostomy, vaginostomy, and vesicostomy as a newborn presented for reconstruction. Her VACTERL workup was negative except for an atretic right kidney. Her ARM index included the cloaca, a normal spine, and sacrum with a lateral sacral ratio of 0.7, predicting good potential for bowel continence. Cystoscopy through the vesicostomy showed a small bladder with normal ureteral orifices, and a closed bladder neck, with no identifiable urethra. A cloacagram showed an atretic common channel, a single small vagina, and a rectum below the pubococcygeal line. The patient underwent a posterior sagittal anorectovaginourethroplasty, vaginal patch using rectum, rectoplasty, and perineal body reconstruction. The urethra was not amenable to reconstruction, so the vesicostomy was preserved and a future Mitrofanoff was planned. Conclusion Urethral atresia is a rare and challenging finding in cloaca patients, and a vesicostomy is needed to drain urine in the newborn period. Preoperative examination under anesthesia, cystoscopy, vaginoscopy, and cloacagram are crucial to identify the precise anatomy and to plan accordingly.

Education and employment as young adults living with spina bifida transition to adulthood in the USA: A study of the National Spina Bifida Patient Registry.

To describe the education and employment transition experience of young adults with spina bifida (YASB) and investigate factors associated with employment. We queried education and employment data from the US National Spina Bifida Patient Registry from 2009 to 2019. We applied generalized estimating equations models to analyze sociodemographic and disease-related factors associated with employment. A total of 1909 participants (850 males, 1059 females) aged 18 to 26 years contributed 4379 annual visits. Nearly 84% had myelomeningocele and, at last visit, the median age was 21 years (mean 21 years 5 months, SD 2 years 10 months). A total of 41.8% had at least some post-high school education, and 23.9% were employed. In a multivariable regression model, employment was significantly associated with education level, lower extremity functional level, bowel continence, insurance, and history of non-shunt surgery. This large, national sample of YASB demonstrated low rates of post-secondary education attainment and employment and several potentially modifiable factors associated with employment. Specific sociodemographic, medical, and functional factors associated with employment are important for clinicians to consider when facilitating transition for YASB into adulthood. Additional research is needed to understand the impact of cognitive functioning and social determinants of health on transition success in YASB. There were low education attainment and employment rates in a large sample of young adults with spina bifida. Specific sociodemographic, medical, and functional factors are associated with employment. Some employment-associated factors, such as continence and self-management skills, are modifiable.

THE FIRST REPORT OF ANGIOEDEMA AND ANAPHYLAXIS WITH TEMPORAL ASSOCIATION TO SEMAGLUTIDE

<h3>Introduction</h3> Semaglutide is an injectable glucagon-like peptide (GLP-1) agonist used for diabetes and weight loss. IgE-mediated reactions have been reported in other GLP-1 agonists, however none have been reported with semaglutide. This case highlights the peculiar timing of anaphylaxis related to subcutaneous semaglutide administration. <h3>Case Description</h3> A 59-year-old woman presented to clinic for evaluation of intermittent angioedema and one episode of anaphylaxis one month after starting semaglutide. Weekly, she developed progressive tongue swelling two days after administration, that resolved within hours. Five months later, she developed anaphylaxis seventeen hours after medication administration. Symptoms included pruritic palmar erythema, lip and tongue angioedema, loss of consciousness, and bowel continence. In the emergency department she was hypotensive with leukocytosis and anion gap lactic acidosis. That morning, she ate foods she has tolerated since, and denied any insect stings, NSAID use, alcohol, and exercise. Within three months of stopping semaglutide, the patient has had only one episode of hour-long mild tongue swelling and palmar erythema. <h3>Discussion</h3> This patient presented with angioedema consistently two days after semaglutide administration. This culminated in anaphylaxis 17 hours after administration. This timing is atypical of type I hypersensitivity reaction. With the medication's peak plasma time of 1-3 days, the consistent timing of the reaction in relation to medication administration, minimal symptoms since stopping semaglutide, and without alternate explanation, this reaction may be explained by drug metabolism with reaction to unknown metabolites. This case highlights the first report, to our knowledge, of angioedema and anaphylaxis with temporal association to semaglutide administration.

Efficacy of Laparoscopic Management of Posterior Urethral Diverticulum in Anorectal Malformations

BackgroundA posterior urethral diverticulum (PUD) is a serious postoperative complication after anorectal malformation correction. Complete resection is technical demanding because of limited retrourethral working space deep in the pelvis. ObjectiveWe pioneered the single-incision laparoscopic approach for PUD excision and evaluated the efficacy. Design, setting, and participantsTwenty-six PUD patients undergoing redo surgeries between June 2011 and June 2021 were reviewed. Surgical procedureA series of transabdominal retraction sutures were placed through the PUD to facilitate dissection. The contents were evacuated to create a working space. Distal PUD dissection was carried along the submucosal layer to prevent injury of the urethra/pelvic nerve complex. The rectal mucosa was peeled off from the junction site for complete PUD excision. The muscular cuff of the distal rectum was then oversewn. MeasurementsOperative time, postoperative recovery, and complications were assessed. Results and limitationsThe mean age of redo surgery was 2.46 yr. The average operative duration was 2.35 h. The mean postoperative hospital stay, resumption of full diet, and bowel movement were 10.23, 2.15, and 1.54 d, respectively. The median follow-up period was 46 mo (12–132 mo). No remnant of PUD, recurrent fistula, or urinary leak was detected. None of the patients had difficulty in urination, urinary dribbling, urinary tract infection, constipation, or soiling. All patients retained morning erection, and two postpubertal patients had ejaculations. ConclusionsOur single-incision laparoscopic redo surgery provides an effective approach for PUD excision. It minimizes complications. It also preserves urinary and bowel continence and sexual function. Patient summaryComplete resection of a posterior urethral diverticulum (PUD) in anorectal malformation is technically demanding because of limited retrourethral working space in the deep pelvis. The outcomes of single-incision laparoscopic PUD excision were satisfactory.

Survey on Untethering of the Spinal Cord and Urological Manifestations among Spina Bifida Patients in Malaysia.

The incidence and severity of urinary tract infections (UTIs) due to spina bifida is poorly understood in Malaysia. Tethering of the spinal cord is a pathological fixation of the cord in the vertebral column that can result in neurogenic bladder dysfunction and other neurological problems. It occurs in patients with spina bifida, and the authors of this study sought to investigate the impact of untethering on the urological manifestations of children with a tethered cord, thereby consolidating a previously known understanding that untethering improves bladder and bowel function. Demographic and clinical data were collected via an online questionnaire and convenient sampling techniques were used. A total of 49 individuals affected by spina bifida participated in this study. UTIs were reported based on patients’ observation of cloudy and smelly urine (67%) as well as urine validation (60%). UTI is defined as the combination of symptoms and factoring in urine culture results that eventually affects the UTI diagnosis in spina bifida individuals irrespective of CISC status. Furthermore, 18% of the respondents reported being prescribed antibiotics even though they had no history of UTI. Therefore, indiscriminate prescription of antibiotics by healthcare workers further compounds the severity of future UTIs. Employing CISC (73%) including stringent usage of sterile catheters (71%) did not prevent patients from getting UTI. Overall, 33% of our respondents reported manageable control of UTI (0–35 years of age). All individuals below the age of 5 (100%, n = 14) were seen to have improved urologically after the untethering surgery under the guidance of the Malaysia NTD support group. Improvement was scored and observed using KUB (Kidneys, Ureters and Bladder) ultrasound surveillance before untethering and continued thereafter. Spina bifida individuals may procure healthy bladder and bowel continence for the rest of their lives provided that neurosurgical and urological treatments were sought soon after birth and continues into adulthood.

Faecal incontinence is associated with an impaired rectosigmoid brake and improved by sacral neuromodulation.

The rectosigmoid brake, characterised by retrograde cyclic motor patterns on high-resolution colonic manometry, has been postulated as a contributor to the maintenance of bowel continence. Sacral neuromodulation (SNM) is an effective therapy for faecal incontinence, but its mechanism of action is unclear. This study aims to investigate the colonic motility patterns in the distal colon of patients with faecal incontinence, and how these are modulated by SNM. A high-resolution fibreoptic colonic manometry catheter, containing 36 sensors spaced at 1-cm intervals, was positioned in patients with faecal incontinence undergoing stage 1 SNM. One hour of pre- and post meal recordings were obtained followed by pre- and post meal recordings with suprasensory SNM. A 700-kcal meal was given. Data were analysed to identify propagating contractions. Fifteen patients with faecal incontinence were analysed. Patients had an abnormal meal response (fewer retrograde propagating contractions compared to controls; p= 0.027) and failed to show a post meal increase in propagating contractions (mean 17 ± 6/h premeal vs. 22 ± 9/h post meal, p= 0.438). Compared to baseline, SNM significantly increased the number of retrograde propagating contractions in the distal colon (8± 3/h premeal vs. 14 ± 3/h premeal with SNM, p= 0.028). Consuming a meal did not further increase the number of propagating contractions beyond the baseline upregulating effect of SNM. The rectosigmoid brake was suppressed in this cohort of patients with faecal incontinence. SNM may exert a therapeutic effect by modulating this rectosigmoid brake.

Utilizing an Interprofessional Team to Develop an Evaluation and Monitoring Outcome Tool for a Pediatric Surgical Rehabilitation Program in Tanzania

ObjectivesTo describe a medical assessment tool developed to track patient outcomes for post-operative, rehabilitative pediatric care in efforts to effectively collect evaluation and monitoring data in a limited resource setting. MethodsThe Plaster House in Arusha, Tanzania partnered with an interdisciplinary academic team (dietetics, nursing, occupational therapy, physical therapy, physician assistant, public health, and social work) from St. Catherine University (St. Paul, MN, USA). Through an 18-month iterative process, the team created an assets map, logic model and evaluation plan. To measure goals in the logic model, an assessment tool was developed to monitor and evaluate patient post-operative recovery for children with cleft lip/palate, spina bifida, skeletal fluorosis, osteomyelitis, burn scar contractures, or clubfoot. Diagnosis-specific indicators were determined collaboratively using evidence-based measures the team agreed would be simple to collect and reliable when different team members collect the measurement. ResultsThe tool evaluates nutritional status, one diagnosis-specific indicator, and three developmental indicators recorded at intake and discharge. For example, a child with spina bifida is evaluated on bladder and bowel continence. If the child is incontinent of bladder or bowel, the tool asks whether management of the incontinence is child managed, parent managed, or not managed. The developmental indicators assess age-appropriate level assessment of everyday tasks, such as activities of daily living, play, and social interaction. ConclusionsThe medical assessment tool serves multiple purposes for the pediatric rehabilitation program, including monitoring participants’ progress, evaluating the effectiveness of current practices, and sharing data with funders.This medical assessment tool has the potential to feasibly capture outcome measurements post-operation on seven correctable disabilities for pediatric rehabilitative care facilities with limited resources. Funding SourcesGHR Foundation.

Surgical management of myelocystocele: a single-center experience with long-term functional outcomes.

Myelocystocele (MCC) is an uncommon form of skin-covered spinal dysraphism. The authors aimed to present long-term functional outcomes of patients treated for MCC with and without associated abnormalities of cloacal development (ACD). All patients with MCC and at least one tethered cord release (TCR) treated at a single institution between 1982 and 2019 were retrospectively reviewed. Demographic, operative, and functional outcome data were analyzed. Of 51 children with MCC, 30 (58.8%) had MCC only and 21 (41.2%) had associated ACD (MCC/ACD). Thirty-two patients (62.7%) had undergone one TCR, while 19 patients (37.3%) had multiple TCRs. Urinary continence assessment was possible in 41 patients (80.4%), and bowel continence assessment was possible in 43 patients (84.3%) who were either older than 6 years or toilet trained. Although patients with MCC only were more likely to void volitionally (p = 0.0001), there was no difference in overall bladder continence based on the presence of ACD (p = 0.15) or the need for additional untethering procedures (p = 0.15). Those with MCC only were more likely to have overall bowel continence (p = 0.0001) and not require any management (p = 0.002), while those with MCC/ACD were more likely to have an ileostomy (p = 0.01). Of the 30 patients with MCC only, 29 (96.7%) were able to ambulate in the community. Of 21 patients with MCC/ACD, 14 (66.7%) were able to ambulate in the community, 5 (23.8%) were not ambulating, and 2 (9.5%) were therapeutic ambulators. A greater proportion of children in the MCC cohort were ambulating in the community (p = 0.01). There was no difference in community ambulation based on the number of TCRs (p > 0.99), but those with multiple TCRs were more likely to use braces (p = 0.01) and require lower-extremity orthopedic surgery (p = 0.01). Patients born with an MCC, with or without an associated ACD, attained long-term favorable outcomes in bladder and bowel continence and ambulation.

Prevalence and outcome of care among patients with spinal cord injury in a Nigerian Tertiary Health Institution

ObjectiveThis study assessed the prevalence, causes, pattern of management and outcome of care among patients SCI in University College Hospital, Ibadan, Nigeria. MethodsThe study adopted a retrospective research design and case files of all patients with spinal cord injury that received treatment at the hospital from 2015 to 2018 were used for the study. A self-developed checklist was used for data collection. Collected data were analysed using the statistical package for the social sciences (SPSS) version 25. The data were presented with descriptive and inferential statistics at a significance level of p = 0.05. ResultsFindings showed that 132 admitted patients out of a total of 850 admissions over four years had SCI with a prevalence rate of 15.5% with highest percentage in 2018 and 65.2% of the SCI resulted from trauma and 34.8% were non-traumatic. Majority of the patients (99.2%) were given analgesics, 97.7% were placed on bed resting, 90.2% received psychotherapy, 89.4% were placed on adequate nutrition, 71.2% were placed on anticoagulants 68.2% placed on catheterization and 57.6% benefited from surgery. Findings also showed that outcomes of care for spinal cord injury ranges from Paraplegia (29.5%), salvaging of bladder or bowel continence (25.0%) and Quadriplegia (15.2%). ConclusionThe study concluded that there is high prevalence of SCI and trauma, road traffic accident and occupational hazard were the major causes of spinal cord injury.