Enema Continence Catheter For Neurogenic Bowel Dysfunction: It Could Be Useful For Bowel Regimen As Well As Clean Intermittent Catheterization For Bladder Dysfunction?

PURPOSE Patients with spina bifida commonly present bowel and bladder dysfunction both of which can affect quality of life (QOL). Neurogenic bowel dysfunction (NBD) is commonly managed in most patients empirically with diet and mild laxatives combined with sporadic enemas or digital manouvres, patients not responding to these measures are often considered as surgical candidates. This study was designed to evaluate the effectiveness of a modified enema continence catheter (ECC) for transanal irrigation on the QOL in young adults with NBD. MATERIAL AND METHODS After institutional committee approval 12 spina bifida patients with NBD (mean age 22.6 years) were enrolled in this multicentric trial. The level of the lesion, ambulatory status, manual dexterity, and the degree of NBD was determined in all. The EEC system for transanal irrigation (Peristeen, Coloplast A/S Kokkedal Denmark) was used for 3 weeks of treatment. The volume of water used, the degree of balloon inflation, and the frequency of enema administration was determined during the first weeks of treatment. NBD symptoms, urinary tract infections (UTI) and QOL were evaluated in all patients before and after the treatment using a tested questionnaire by urotherapist. Statistical analysis was performed using the McNemar Test and Sign Test. RESULTS Twenty-five percent of the patients noted a reduction or eliminated the use of pharmaceuticals by the end of treatment study. 75% of the patients became less dependent on their caregiver as well. Successful outcome was recorded regarding fecal continence in 66.6%, constipation in 58.3%.QOL improved in 75%. The time necessary for evacuation and the need of mechanical stimulation were reduced in 58.3% and 66.6% respectively. UTI disappeared in all. CONCLUSIONS ECC is a simple therapeutic method for managing NBD which results in an improved QOL too. For this reason we suggest to consider ECC in NBD as clean intermittent catheterization for neurogenic bladder.