J Pediatr Surg. 2022 Aug;57(8):1681-1686. doi: 10.1016/j.jpedsurg.2022.04.011.Epub 2022 Apr 22.

Maria E Knaus ¹, Tariku J Beyene ², Jessica L Thomas ³, Elias R Maloof ⁴, Alberta L Negri Jimenez ⁴, Ihab Halaweish ³, Richard J Wood ³, Alessandra C Gasior ⁵

Author information

¹Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA; Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA. Electronic address: Maria.knaus@nationwidechildrens.org.

²Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA.

³Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA.

⁴Ohio State University College of Medicine, The Ohio State University, 370 West 9(th) Ave, Columbus, OH 43210, USA.

⁵Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA; Department of Colon and Rectal Surgery, The Ohio State University, 410 West 10(th) Ave, Columbus, OH, 43210, USA.

Abstract

Objective: Bowel management programs are efficacious in pediatric patients with fecal incontinence or intractable constipation unresponsive to standard treatment. No studies have been done examining outcomes in adults. The objective of this study was to assess continence and quality of life outcomes in adults who have underwent bowel management program.

Methods: A retrospective review of patients 16 or older at the time they underwent a bowel management program for fecal incontinence or constipation was performed. Data collected included intake and follow-up stool and urinary continence, patient-reported outcomes measures (Cleveland Clinic Constipation Score, Baylor Continence Scale, Vancouver Symptom Score for Dysfunctional Elimination), and an age-adjusted health-related quality of life measure.

Results: The cohort included 38 patients with a median age of 19 years (range: 16-55) when they underwent our program. 50% of patients were female and the majority (33, 87%) were White. The most common diagnosis was anorectal malformation (16, 42%) followed by functional constipation (10, 27%). Stool continence rates improved after undergoing the program (52.7% prior to 87.6% at follow-up, p<0.01). There was significant improvement in the Baylor Continence Scale, Cleveland Clinic Constipation Score, and PedsQL (p<0.05).

Conclusions: Adult patients who underwent a bowel management program for severe fecal incontinence or constipation show significant improvement in stool continence rates, patient-reported outcomes measures, and quality of life. A bowel management program (in-person or via telemedicine) is a feasible treatment strategy for adult patients who fail standard management of fecal incontinence or constipation and should be offered when appropriate.

Level of evidence: III.