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Advice for Bowel continence for Spina Bifida inChildrenLearn more about Spina Bifida athttp://www.spinabifida.net
BOWEL MANAGEMENT• Most children with spina bifida need assistancewith bowel continence• The goal is to haveone BM a day on...
CONTROL CENTERS
BOWEL MANAGEMENT
BOWEL MANAGEMENT
GOALS• Non constipated stool• Social continence by school age• Independence
WHERE TO BEGIN?• Prevent constipation• Toilet sitting when developmentallyappropriate
WHERE TO BEGIN?• Track bowel movements• Time of day• Number per day
CONSISTENCYTOO FIRMTOO SOFT
WHERE TO BEGIN?
BOWEL MANAGEMENT Multiple therapies available Trial and error approach Start simple and work up to the morecomplex Goa...
DIETARY IMPACT• Fiber and fluids are key to success• Infants: water in between formula feeds
DIETARY IMPACT• Mix prune juice with apple juice• Add fiber supplements
DIETARY IMPACT• Toddlers: encourage raw fruits and vegetables• “Finger foods”
DIETARY IMPACT Most toddlers like foods that cause constipation◦ Peanut butter◦ Milk◦ Cheese◦ Mac and cheese
DIETARY IMPACT
WHERE TO BEGIN?• Fiber supplements• Many different brands• Check with your physician before giving to infants
WHERE TO BEGIN?Infants• Prevent constipation• Fruit• Fruit juices• Water• Fiber additives
TIMING
WHERE TO BEGIN?Toddlers Prevent constipation Start toilet sitting◦ 15-20 minutes after eating
WHERE TO BEGIN?• Sit with feet well supported• Grunt or bear down• Blow bubbles or pinwheel
WHERE TO BEGIN?• This approach is called habit training• Pick a time that works for you
WHERE TO BEGIN?Older child• Use the reward system• Sticker chart with a prize
BOWEL MANAGEMENT Start with an assessment of current schedule Bowel tracking noting:◦ Frequency◦ Consistency◦ Pattern◦ I...
NEXT STEPSIf habit training alone is not effective?• Add stimulants
STIMULANTS• Oral• Rectal:• Enemas• Suppositories
STIMULANTS
STIMULANTSChoose those that:• Do not cause cramping• Are palatable• Are predictable
BOWEL MANAGEMENT
BOWEL MANAGEMENT• CONE enema• Enema tubing has a cone which holds fluids in therectum• Sit on toilet to do program• Older ...
CONE ENEMA
CLEANOUTS
CLEANOUTS• Oral agents alone• In combination with enemas
CLEANOUTS Miralax Takes 5-8 days to begin working Massive results Not predictable for maintenance
CLEANOUTS• Milk of Magnesia• Large dose over a short period of time• Works in 48 hours or less• May cause cramping• Diffic...
ACE PROCEDURE• Antegrade Continence Enema• Also known as MACE (Malone AntegradeContinence Enema)• Indicated when all other...
ACE PROCEDURE A tube like structure is created from the appendix The tube goes from the ascending colon to the rightlowe...
ACE PROCEDURE• In patients with intractable fecal incontinence• The Mitrofanoff principle used to construct acontinent con...
ACE PROCEDURE• Enemas in an antegradefashion into the cecum to cleanout the large bowel
ACE PROCEDURE• Challenges• Volume needed to clean out• Length of time to perform
ACE PROCEDUREUsing the MACE procedure fecal continence ratesand satisfaction have been reportedapproaching 100%
BOWEL MANAGEMENT
BOWEL MANAGEMENT• Each child should have an individualized program• Trial and error until success
Questions?• For more educational resources about Spina Bifida please visithttp://www.spinabifida.net
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Advice for bowel continence for Spina Bifida in Children

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Learn more about Spina Bifida in Children at http://www.spinabifida.net

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Advice for bowel continence for Spina Bifida in Children

  1. 1. Advice for Bowel continence for Spina Bifida inChildrenLearn more about Spina Bifida athttp://www.spinabifida.net
  2. 2. BOWEL MANAGEMENT• Most children with spina bifida need assistancewith bowel continence• The goal is to haveone BM a day onthe toilet at anappropriate time
  3. 3. CONTROL CENTERS
  4. 4. BOWEL MANAGEMENT
  5. 5. BOWEL MANAGEMENT
  6. 6. GOALS• Non constipated stool• Social continence by school age• Independence
  7. 7. WHERE TO BEGIN?• Prevent constipation• Toilet sitting when developmentallyappropriate
  8. 8. WHERE TO BEGIN?• Track bowel movements• Time of day• Number per day
  9. 9. CONSISTENCYTOO FIRMTOO SOFT
  10. 10. WHERE TO BEGIN?
  11. 11. BOWEL MANAGEMENT Multiple therapies available Trial and error approach Start simple and work up to the morecomplex Goal is to have the childbe independent in the program
  12. 12. DIETARY IMPACT• Fiber and fluids are key to success• Infants: water in between formula feeds
  13. 13. DIETARY IMPACT• Mix prune juice with apple juice• Add fiber supplements
  14. 14. DIETARY IMPACT• Toddlers: encourage raw fruits and vegetables• “Finger foods”
  15. 15. DIETARY IMPACT Most toddlers like foods that cause constipation◦ Peanut butter◦ Milk◦ Cheese◦ Mac and cheese
  16. 16. DIETARY IMPACT
  17. 17. WHERE TO BEGIN?• Fiber supplements• Many different brands• Check with your physician before giving to infants
  18. 18. WHERE TO BEGIN?Infants• Prevent constipation• Fruit• Fruit juices• Water• Fiber additives
  19. 19. TIMING
  20. 20. WHERE TO BEGIN?Toddlers Prevent constipation Start toilet sitting◦ 15-20 minutes after eating
  21. 21. WHERE TO BEGIN?• Sit with feet well supported• Grunt or bear down• Blow bubbles or pinwheel
  22. 22. WHERE TO BEGIN?• This approach is called habit training• Pick a time that works for you
  23. 23. WHERE TO BEGIN?Older child• Use the reward system• Sticker chart with a prize
  24. 24. BOWEL MANAGEMENT Start with an assessment of current schedule Bowel tracking noting:◦ Frequency◦ Consistency◦ Pattern◦ Incontinence Start young assessing for constipation
  25. 25. NEXT STEPSIf habit training alone is not effective?• Add stimulants
  26. 26. STIMULANTS• Oral• Rectal:• Enemas• Suppositories
  27. 27. STIMULANTS
  28. 28. STIMULANTSChoose those that:• Do not cause cramping• Are palatable• Are predictable
  29. 29. BOWEL MANAGEMENT
  30. 30. BOWEL MANAGEMENT• CONE enema• Enema tubing has a cone which holds fluids in therectum• Sit on toilet to do program• Older children can perform independently
  31. 31. CONE ENEMA
  32. 32. CLEANOUTS
  33. 33. CLEANOUTS• Oral agents alone• In combination with enemas
  34. 34. CLEANOUTS Miralax Takes 5-8 days to begin working Massive results Not predictable for maintenance
  35. 35. CLEANOUTS• Milk of Magnesia• Large dose over a short period of time• Works in 48 hours or less• May cause cramping• Difficult to deliver
  36. 36. ACE PROCEDURE• Antegrade Continence Enema• Also known as MACE (Malone AntegradeContinence Enema)• Indicated when all otherapproaches have failed
  37. 37. ACE PROCEDURE A tube like structure is created from the appendix The tube goes from the ascending colon to the rightlower abdominal wall Enemas every three days empty the colon completely
  38. 38. ACE PROCEDURE• In patients with intractable fecal incontinence• The Mitrofanoff principle used to construct acontinent conduit to the bowel (MACE)
  39. 39. ACE PROCEDURE• Enemas in an antegradefashion into the cecum to cleanout the large bowel
  40. 40. ACE PROCEDURE• Challenges• Volume needed to clean out• Length of time to perform
  41. 41. ACE PROCEDUREUsing the MACE procedure fecal continence ratesand satisfaction have been reportedapproaching 100%
  42. 42. BOWEL MANAGEMENT
  43. 43. BOWEL MANAGEMENT• Each child should have an individualized program• Trial and error until success
  44. 44. Questions?• For more educational resources about Spina Bifida please visithttp://www.spinabifida.net

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