A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

Study design: Systematic review. Objectives: To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness. Setting: International literature. Method: Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion. Results: Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n = 509). In patients using RCE (n = 190) an 80% continence rate was reached. Patients following surgical treatment (n = 469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management. Conclusion: Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment