This document discusses various conditions in children that can lead to bowel dysfunction, including spinal cord injuries, sacral agenesis, necrotizing enterocolitis (NEC), Ehlers-Danlos syndromes (EDS), and spina bifida. It provides details on the symptoms and impacts of each condition, such as neurogenic bowel from spinal cord injuries depending on the level of injury. It also discusses challenges children face in managing bowel issues, like negative quality of life impacts and potential lack of treatment due to lack of knowledge.

2. Conditions in Children
that may lead to
Bowel Dysfunction
Bev Collins
Clinical Nurse Lead

3. Conditions in Children affecting Bowel Function
• Hirschsprungs
• Spinal cord injury
• Sacral agenesis
• Necrotising Enterocolitis NEC
• Ehlers–Danlos syndromes EDS
• Spina Bifida / hydrocephalus

4. Spinal Cord Injury
• Neurogenic bowel
• Level of injury will determine
function and bowel dysfunction
• Specialist care: paediatrics
and / or Specialist Spinal Centre
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
C1-C3 Neck Muscles
C4 Diaphragm
C5 Deltoid (shoulder)
C6 Wrist
C7 Triceps
C7-C8 Fingers
T1 Hand
T2-T12 Intercostals (Trunk)
T7-L1 Abdominals
T11-L2 Ejaculation
L2 Hips
L3 Quadriceps
L4-L5 Hamstrings – Knee
L4-S1 Foot
S2 Penile erection
S2-S3 Bowel and bladder

5. Sacral agenesis
• Congenital disorder
• Abnormal development of
lower spine whilst developing
• 1:25,000 live births
• Absence of sacrum

6. Necrotising Enterocolitis (NEC)
• Neonatal condition
• 1: 250 live Births
• Premature, low birth weight babies
and in fewer babies born at term
• 1:4 babies will require surgery
• 3:5 babies will require further surgery
• 3 babies in UK die every
week with NEC
Diseased part
of bowel removed
Ostomy created Cut ends of
bowel joined
First surgery Second surgery
(weeks later)

7. Ehlers–Danlos syndromes (EDS)
• Genetic tissue disorder –
often misdiagnosed
• Symptoms include:
loose joints, stretchy skin
• 1:5000 globally
• No cure. Prognosis depends
on type of EDS
• Heartburn / Constipation /
Stress incontinence

8. Ehlers–Danlos syndromes (EDS)
Bowel issues:
• Constipation
• Weak peristalsis
• Slow transit
• Laxatives often prescribed……
exploding nappies!!!

9. Ehlers–Danlos syndromes (EDS)

10. Spina Bifida – Split spine
• Spina bifida is when a baby's spine and
spinal cord does not develop properly in
the womb, causing a gap in the spine.
• In spina bifida, part of the neural tube does not
develop or close properly, leading to defects in the
spinal cord and bones of the spine (vertebrae).
• Spina bifida is a type of neural tube defect.
The neural tube is the structure that eventually
develops into the baby's brain and spinal cord.
• The neural tube starts to form in early pregnancy
and closes about 4 weeks after conception.
Dura Mater
Spinal Cord
Spinal Fluid
Vertebra

11. Spina Bifida
Spina bifida occulta
(opened posterior vertebral body)
Meningocele
(protrusion of the meninges)
Myelomeningocele
(protrusion and opened spinal cord)

12. Types of Spina Bifida – Open SB
• Myelomeningocele is the most serious and more common of the two forms of
cystic spina bifida. Here the cyst not only contains tissue and cerebrospinal fluid
(CSF) but also nerves and part of the spinal cord. The exposed spinal cord is
damaged by the fluid in the womb during pregnancy and may also not develop
properly. As a result, there is nearly always some resulting paralysis and loss of
sensation. Nerves to and from the spinal cord emerging below the damaged
region may not pass messages to the brain. The extent of this can be patchy and
difficult to predict.
• The lower on the spine, and smaller the lesion, the less severe the resulting
impairments are likely to be. Bladder and bowel problems occur in most people
with myelomeningocele, as the nerves come from the very bottom of the spinal
cord, and are always below the lesion. It is also necessary to have intact nerve
pathways to the brain for complete control and sensation.

15. Types of Spina Bifida
Meningocele
In this form, the sac contains meninges (tissues
which cover the brain and spinal cord) and CSF,
but no spinal tissue. Development of the spinal
cord may be affected, but impairment is usually
less severe than myelomeningocele. Meningocele
is the least common form of spina bifida.
Spina Bifida Occulta
Spina bifida occulta (SBO) is a type of spinal
dysraphism or ‘closed’, skin-covered form
of spina bifida. Estimates vary, but between
5% and 10% of people may have spina bifida
occulta.
Closed Spina Bifida
Open Spina Bifida

16. Hydrocephalus
• A build up of cerebrospinal fluid on the
brain. Hydrocephalus can have a range
of physical and cognitive effects.
• Congenital hydrocephalus means
it is present at birth.
• Can be genetic, due to a maternal
infection or cysts in brain.
• Acquired hydrocephalus means
it has occurred during life.
• Maybe due to haemorrhage,
prematurity, tumour, meningitis.

17. Folic Acid
Folic acid before and during pregnancy
• Recommended dose 400 micrograms folic acid tablet every day
before pregnancy and until 12 weeks of pregnancy.
• Folic acid can help prevent birth defects known as neural tube
defects, including spina bifida.
• If folic acid is not taken before pregnancy, it should be started
as soon as pregnancy is confirmed.
• Eating foods that contain folate (the natural form of folic acid),
such as green leafy vegetables are recommended.
• Some breakfast cereals and some fat spreads, such as margarine,
may have folic acid added to them.
• It's difficult to get the amount of folate recommended for a healthy
pregnancy from food alone, which is why it's important to take a
folic acid supplement.

18. Vitamin B12
• Taking vitamin B12
• Vitamin B12 works closely with folate, and low levels in the
bloodstream increase the chance of the baby having NTD.
Many foods rich in B12 are ‘out of fashion’ these days, such as
eggs and red meat; vegetarians and vegans may need to take
extra B12 to get enough.

19. Challenges for the child
with bowel issues
• Negative impact on quality of life
• Are still taboo to talk about
• Lack of knowledge about treatment options
is often the reason why some children are
left untreated, or get suboptimal treatment
• Often other co-morbidities
• Potential bullying

20. Under 3’s treatment
• Laxatives
• Anti diarrhoeal medication
• Abdominal massage
• Surgery

21. Wellspect HealthCare, Aminogatan 1, P.O. Box 14, SE-431 21 Mölndal, Sweden. Phone: +46 31 376 40 00.