From the Guidelines
Fecal stasis in patients with spina bifida does not necessarily require a general surgery consultation, and management should start with a comprehensive bowel management program tailored to the individual's neurological impairment level. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of conservative management before considering surgical interventions 1.
Key Components of Bowel Management
- Regular toileting schedule, typically 30-60 minutes after meals to take advantage of the gastrocolic reflex
- Dietary modifications, including adequate fluid intake (1.5-2 liters daily) and sufficient fiber (20-30 grams daily) through fruits, vegetables, and whole grains
- Pharmacological management with stool softeners like docusate sodium (100-300 mg daily) or polyethylene glycol (17 grams in 8 ounces of water daily) to prevent hard stools
- Stimulant laxatives such as senna (8.6-17.2 mg daily) or bisacodyl (5-10 mg daily) to help promote bowel movements
Additional Interventions for Severe Cases
- Rectal stimulation with glycerin or bisacodyl suppositories, or digital stimulation to trigger reflex evacuation
- Enemas (phosphate or saline) for impaction, using 10-20 ml/kg up to 500 ml
- Transanal irrigation systems or antegrade continence enemas through a surgically created channel for refractory cases
Surgical Considerations
Surgical options, including sacral nerve stimulation, may be considered in patients who have failed conservative therapy, but the evidence for these interventions is limited, and they should be approached with caution 1. The decision to involve general surgery should be made on a case-by-case basis, considering the severity of the condition, the failure of conservative management, and the potential benefits and risks of surgical intervention.
Best Practice Advice
Biofeedback therapy is recommended as the treatment of choice for defecatory disorders 1. Sacral nerve stimulation and other surgical procedures should be considered only when conservative management has failed, and the patient's condition warrants more invasive interventions.
From the Research
Management of Fecal Stasis in Spina Bifida Patients
- Fecal stasis in patients with spina bifida can be managed through various treatment options, including conservative interventions such as diets and oral laxatives, as well as trans-anal irrigations and antegrade continence enemas 2.
- The goals of a successful bowel management program in patients with spina bifida include predictable bowel movements, social continence, and eventual independence 2.
- A multidisciplinary team approach is recommended for managing bowel dysfunction in patients with spina bifida, taking into account the patient's developmental age and individual needs 2, 3.
Role of General Surgery Consultation
- While general surgery consultation may not be necessary for all patients with spina bifida and fecal stasis, it may be required for certain individuals who require more invasive procedures, such as antegrade continence enemas or colostomy 4, 5.
- The decision to involve a general surgeon should be made on a case-by-case basis, taking into account the patient's specific needs and medical history 4, 5.
Treatment Options and Outcomes
- Treatment options for fecal stasis in patients with spina bifida include oral medications, suppositories, rectal enemas, antegrade continence enemas, and digital stimulation or disimpaction 3, 5.
- The effectiveness of these treatment options can vary depending on the individual patient and their specific condition, with some studies reporting high success rates for bowel management programs in patients with spina bifida 4, 6.
- Factors associated with severe fecal incontinence in patients with spina bifida include male sex, obesity, urinary incontinence, and stool consistency, rather than neurologic level or other neurologic features 3, 6.