Treatment of defecation disorders by colonic enemas in children with spina bifida.

Faecal incontinence and constipation are well known problems in children with spina bifida. Effective treatment can be difficult and this gave the condition a low priority despite the obvious physical and psychological sequelae. Positive experience with colonic enemas (CE) in the paediatric post-operative care have led us to adopt this method as the treatment of choice for defecation disorders in children with spina bifida. In 41 spina bifida children (mean age 8.4 years, range 7 months to 22 years), retrograde CEs with hand-warm tap water were given at home from once a day to twice per week. Satisfaction with the procedure was evaluated with a questionnaire sent out after a mean follow-up period of 33 months (range 6 to 55 months). The indications to start CEs were faecal incontinence (27%), constipation (27%) or both. 34% of 41 children also had other gastrointestinal complaints, 7% had headaches, 29% had poor appetite and 15% felt generally unwell. Before the start of CE 22% of the children had been on a diet, 37% on oral laxatives, 31% on a rectal laxative and 44% had to have manual evacuations. 90% used diapers on a daily basis. At the end of the follow-up period 27% of the children were still on a diet and 17% still used oral laxatives but rectal laxatives were no longer used nor were manual evacuations necessary. 66% of the 41 children were completely faecally continent and constipation occurred only occasionally, no child had faecal retention or impaction. At follow-up 39% still used diapers regularly and 20% used a panty-line and complaints of abdominal pain, headache and poor appetite were rare. Satisfaction with the procedure was rated highly by 63% of parents and children and good by 37% but 15% of the children found regular CEs painful. It is concluded from the study that CEs are therapeutically effective in the treatment of both faecal incontinence and constipation in children with spina bifida. The procedure is well tolerated even by very young children. Long-term histopathological effects of daily CEs on the lower gastrointestinal tract needs to be evaluated by future research.