The effects of transanal irrigation as a stepwise bowel management program on the quality of life of children with spina bifida and their caregivers

Study design: Experimental, prospective study. Objectives: Fecal incontinence and constipation affect the quality of life (QOL) of children with spina bifida and their caregivers. We evaluated the clinical efficacy of a stepwise bowel management program on QOL for children with spina bifida and their caregivers. Setting: Republic of Korea. Methods: Between December 2010 and April 2011, 53 children with constipation, fecal incontinence or both underwent a stepwise bowel management program at our spina bifida clinic. The children and their caregivers were evaluated before and after this program using a self-administered questionnaire. Results: Among the children, 11.3% received only oral laxatives and controlled well, 88.7% received transanal irrigation. After this program, the mean number of episodes of fecal incontinence per week, number of diaper changes and total time for bowel care decreased from 6.9 to 0.5 (P = 0.004), from 1.6 to 0.2 (P = 0.001) and from 27 to 15.9min (P = 0.003), respectively. Caregivers and children were able to leave their houses more often (P = 0.006), and caregivers' bothersomeness, anxiety and depression due to bowel care decreased (P<0.001). Factors related to family relationships (P = 0.265) and financial impact (P = 0.071) improved, but not significantly. Conclusions: We observed significant improvement in defecation symptoms and QOL scores of spina bifida patients who underwent this program. We recommend that this simple therapeutic method be considered as a safe and valid choice for the treatment of chronic constipation and fecal incontinence.