Neurogenic faecal incontinence in children with spina bifida: rectosphincteric responses and evaluation of a physiological rationale for management, including biofeedback conditioning.

The rectosphincteric responses of 22 spina bifida (SB) children, aged 3.0 to 11.0 years, with frequent neurogenic faecal incontinence were investigated by clinical and anomanometric techniques and a bowel habilitation programme based on the physiological rationale of timed regular and complete evacuations, regulation of bowel habit and faecal consistency by diet and biofeedback conditioning of rectosphincteric responses. Eighteen patients had perianal anaesthesia, flail anus and absent anorectal reflex, but some degree of (reduced) rectal sensation. Four had reduced perianal sensation and normal to high pressure external sphincter and a megarectum apparently causing an absence of rectal sensation. Twenty were unable to expel the rectal balloon voluntarily. After biofeedback exercises (2-5 sessions) and a home programme of evacuation and diet, 21 of the 22 achieved satisfactory continence over 2-6 months with improved rectal sensation and ability to evacuate voluntarily. This experience suggests that early anorectal evaluation and a comprehensive bowel habilitation programme may be an effective approach to the prevention of disability due to faecal incontinence in SB children.