WOFAPS 2025 8th World Congress of Pediatric Surgery

Aminah AH Al Nafesa

King Abdullah Specialized Children Hospital (KASCH)

Purpose:

To evaluate bowel management in children with fecal incontinence due to
colorectal conditions and to discuss the effectiveness, failure and compliance of
different protocols.

Methodology:

A retrospective cohort chart review of pediatric patients attending bowel management clinic in a tertiary center in Riyadh, Saudi Arabia over five years period
(2022- 2025). Data collection included patient demography, Bowel management program
include saline enema administration (retrograde vs antegrade), medication program either laxative or motility slowing agents, or combination. Success, failure and
compliance rates were calculated. Success is defined as clean underwear for 24 hours. Patients with colorectal conditions such as Anorectal malformation, Hirschsprung disease, and idiopathic constipation) were included while Spina bifida, neurogenic disorder and cloaca exstrophy were excluded.

Results:

We included 77 pediatric patients (2-18 years) with median age of 8 years who were enrolled in bowel management program at our center, who are on bowel management using multiple protocols in which was individualized according to patients’ need and age at presentation. The majority were boys (65%). The underlying colorectal conditions were anorectal malformation (70%), followed by Hirschsprung's disease (22%) then idiopathic constipation (8%).
Thirty-six patients (47%) were on saline irrigation, twenty-four patients (31%) were switchers between programs, twelve patients (16%) were on laxatives, and two patients (3%) were on loperamide alone. Three patients (4%) were on saline irrigation and loperamide.
The doses and regimens used were calculated according to patients’ weight and need.
The volume of saline enema ranges from 50 to 900 ml. For the laxatives, the highest
Senna dose was 77.4 mg, and the lowest needed dose was 8.6 mg compared to
Bisacodyl dosage ranges from 2.5 to 5 mg. Loperamide doses ranges from 6 to 8 mg
divided doses.
The overall treatment success rate was (81%), of those the majority were diagnosed
with anorectal malformation (60%). Treatment failure was (9%), this was attributed to either anatomical factors such as short colon or patients’ factors such as compliance. Ten percent of patients didn’t complete the protocol and were placed on hold mainly by their caregivers.

Conclusion:

Bowel management program has proved successful since its implementation. The underlying condition remains the main determinant of success of any program as well as compliance. Our study highlights the importance of individualized approaches in optimizing treatment outcomes for pediatric patients with fecal incontinence.