Bowel management programme in patients with anorectal malformations.

OBJECTIVES

To establish an effective and practical bowel management protocol to achieve social continence in children operated for anorectal malformations.

METHODS

The quasi-experimental study was conducted from January to December 2021 at the Colorectal Clinic of the National Institute of Child Health, Karachi, and comprised patients aged >3 years who had completed surgical management for anorectal malformations. Tailored modifications were made to a one-week bowel management boot camp to adapt to institutional constraints and the practical needs of the patient population. History, examination, abdominal X-ray and incontinence score were recorded before and after the commencement of high-volume saline enemas. Data was analysed using SPSS 22.

RESULTS

Of the 80 patients, 46(57.5%) were boys with mean age 6.74±3.24 years and 34(42.5%) were girls with mean age 5.41±1.84 years. Among the boys, rectobulbar fistula was the most common anomaly 26(56.5%), whereas rectovestibular fistula was the most frequent anomaly in girls 20(58.8%). The mean incontinence score at presentation was 5.375±1.72, which improved significantly to 3.637±1.74 following bowel management (p<0.001). For the soiling component, the mean score difference was 1.275±0.45 (p<0.001).

CONCLUSION

Modified bowel management programme was effective in keeping the incontinent and constipated patients after anorectal malformation surgical treatment.