Is a colostomy (surgical creation of an opening in the colon) commonly required for patients with spina bifida?

Colostomy in Spina Bifida Patients

Colostomy is not commonly required as a first-line intervention for spina bifida patients but serves as a definitive third-line treatment option for those with severe fecal incontinence who have failed conservative measures and other surgical interventions. 1, 2

Bowel Management Algorithm for Spina Bifida Patients

First-Line Approaches (Success Rate ~50%)

• Conservative therapies should be tried first, including dietary modifications, laxatives, suppositories, and manual evacuation 2
• Retrograde enemas have approximately 75% success rate when initial medical management fails 2

Second-Line Approaches

• Antegrade Continence Enema (MACE/ACE) procedure should be considered when conservative measures fail, with 77% of patients achieving complete or near-complete fecal continence 2, 3
• This procedure provides improved social confidence, hygiene, and independence but requires 20-60 minutes for instillation and washout 2

Third-Line Approach: Colostomy

• Colostomy should be considered in patients with severe fecal incontinence who have failed conservative treatment and are not candidates for or have failed other interventions 1, 2
• Approximately 2.8% of spina bifida patients in the National Spina Bifida Patient Registry underwent ileostomy/colostomy procedures 3

Benefits of Colostomy in Spina Bifida Patients

• Provides definitive management of fecal incontinence, which has significant impact on quality of life 2, 4
• Significantly reduces time required for bowel management compared to conservative measures 5, 6
• Patients report higher social function scores and improved coping, embarrassment, lifestyle, and depression scores compared to those with fecal incontinence 1
• 84% of patients who had a colostomy for fecal incontinence would choose to have the procedure again, indicating high satisfaction rates 1, 4
• Can improve independence with bowel care in approximately 20.8% of patients 6

Factors Associated with Higher Likelihood of Colostomy

• Patient characteristics associated with increased likelihood of bowel management surgery include:
  • Older age 3
  • White race 3
  • Non-ambulatory status 3
  • Higher-level lesions 3
  • Myelomeningocele lesion type 3
  • Female sex 3
  • Private health insurance 3

Risks and Complications

• Mortality rate associated with colostomy procedure is approximately 2% 1, 7
• Potential complications include:
  • Bleeding and cardiopulmonary events related to anesthesia 1
  • Parastomal hernia 1, 4
  • Skin rashes, leakage, and ballooning around stoma 1
  • Rectal discharge (most common long-term complication) 6

Clinical Implications

• Early colostomy formation can be safe and effective, contrary to traditional approaches that delay this intervention 6
• Colostomy should be discussed as an option earlier in the care pathway for appropriate candidates 5, 6
• Significant variation exists in rates of procedures for neurogenic bowel management among spina bifida treatment centers 3
• Preoperative stoma site marking by a wound/ostomy nurse is vital for optimal surgical outcomes 5

While colostomy is not commonly required for most spina bifida patients, it represents an important definitive treatment option for those with severe, refractory fecal incontinence who have failed other management strategies.