Initial Outcomes in a Bowel Management Clinic for Pediatric Patients with Complex Colorectal Disease: A Systematic Review

Background/Aim: Surgical correction of pediatric anorectal malformation (ARM) and Hirschsprung’s disease (HD) is the first step to achieve continence goals in pediatric patients with these complex conditions. Surgery alone may or may not be sufficient in managing constipation and fecal incontinence as the child grows. Patients with constipation and fecal incontinence secondary to ARM or HD may benefit from a focused bowel management program as a secondary intervention for incontinence. This review is aimed to systematically evaluate the published evidence in this group of patients. Methods: This systematic review was conducted using MEDLINE National Institute of Health (NIH) PubMed, Cochrane Database, and the Texas Medical Center Library journal search online database. Search terms were bowel, management, program, children, and fecal incontinence. This review also referenced the guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results: This search yielded 120 articles of which 17 were pertinent to this study. The 17 selected articles serve as the basis for this clinical review. This search yielded 13 retrospective reviews, four prospective studies, one validation study, and one systematic review. The systematic review that is included in this study focuses on patients with idiopathic constipation. This article was helpful for this review because it highlights an adjunct therapy that can be used in a bowel management program, including surgical procedures like and appendicostomy or cecostomy for antegrade enemas. Though there are several articles related to a bowel management program for fecal incontinence, the review is limited in children and program structure. Conclusion: Structured bowel management programs appear to be effective for children and adults with fecal incontinence or constipation due to functional constipation, ARM, or HD. A bowel management clinic with limited support staff that provides electronic communication to families, allowing for small yet beneficial changes in their treatment regimen, results in improved clinical outcomes. Additional studies regarding the effect on the quality of life for both the patients and the caregivers are needed