Originals
Use of Warm Water Enema to Prompt Daily Defecation in Children With Spina Bifida
2017 Volume 53 Issue 1 Pages 43-48
Details
2017 Volume 53 Issue 1 Pages 43-48
Purpose: Fecal incontinence in school-age children with spina bifida was treated using warm water enema to prompt and control daily defecation.
Methods: We recommended warm water enema for 12 children with spina bifida. A ConvaTec water enema kit® (with stoma cone) was used as the intestinal washing device. The average age was 9.4 years (4.4 to 14.3 years). The stoma cone was directly inserted into the anus and 300-1,500 ml (mean 800 ml) of warm water was poured into the large intestine in order to prompt daily defecation. Daily self-administered warm water enemas were tried for the patients who continued warm water enema for over 10 years, and the patients were able to perform daily self-urethral catheterization.
Results: Anorectal manometry examination was performed in 12 children, and rectal-anal reflux was positive in all children. The mean anal canal pressure was 33.4 ± 11.1 mmHg and was within the normal range in all children. Warm water enemas were initiated in 12 children with the agreement of the children and permission of their parents. The procedure was used continuously for 10 of the 12 children. Two children withdrew from the study. Fecal incontinence at school was improved in 8 of 10 children, and underwear smearing at the school was minimized in 6 of 10 patients. Bloody stool was observed as a complication in one child, who used too much warm water. The water was changed to normal saline and the total volume of enema was limited to less than 1,000 ml; then, the bloody stool did not recur. Daily self-administered warm water enemas were tried in 10 children, and they were able to perform daily self-urethral catheterization. Even then, it was very hard for the children to continue, and parental assistance was needed.
Conclusion: Daily warm water enemas are useful in prompting daily defecation in children with spina bifida, which improved fecal incontinence in social settings such as in school. However, self-administered warm water enema was very hard for the children, and parental support was needed.
