Bowel management program in patients with anorectal malformations

Abstract

Objective: To establish an effective and practical bowel management protocol to achieve social continence in children operated for anorectal malformations.

Method: The quasi-experimental study was conducted from January to December 2021 at the Colorectal Clinic of the National Institute of Child Health, Karachi, and comprised patients aged >3 years who had completed surgical management for anorectal malformations. Tailored modifications were made to a one-week bowel management boot camp to adapt to institutional constraints and the practical needs of the patient population. History, examination, abdominal X-ray and incontinence score were recorded before and after the commencement of high-volume saline enemas. Data was analysed using SPSS 22.

Results: Of the 80 patients, 46(57.5%) were boys with mean age 6.74±3.24 years and 34(42.5%) were girls with mean age 5.41±1.84 years. Among the boys, rectobulbar fistula was the most common anomaly 26(56.5%), whereas rectovestibular fistula was the most frequent anomaly in girls 20(58.8%). The mean incontinence score at presentation was 5.375±1.72, which improved significantly to 3.637±1.74 following bowel management (p<0.001). For the soiling component, the mean score difference was 1.275±0.45 (p<0.001).

Conclusion: Modified bowel management programme was effective in keeping the incontinent and constipated patients after anorectal malformation surgical treatment.

Key Words: Faecal incontinence, Constipation, Anorectal malformations, ARMs, Colorectal surgery, Bowel management.