Impact of the Bowel Management Program on the quality of life in children with fecal incontinence

Introduction Patients after pull-through operation for Hirschsprung's disease (HD) are at high risk of defecation disorders. This study aimed at investigating their long-term outcomes and quality of life (QoL) in comparison with controls. Patients and Methods Patients older than 5 years operated on for HD were interviewed to complete detailed questionnaires on bowel function. Patients without neurologic impairment were enrolled in a QoL survey to compare with controls matched for sex and age and selected randomly from the general population using sampling set in a ratio of four controls to one case of HD. Results In total, 53 operated patients were enrolled. Mean age of the patients was 16 ± 8 years, with 68% boys. Rectosigmoid aganglionosis was the most seen form of HD in 38 (72%) cases. Open Soave was performed in 40 (75.5%) cases, and minimally invasive surgery Soave (MIS Soave) in 13 (24.5%) cases. At investigation, prevalence of fecal incontinence and constipation were 22.6 and 13.2%, respectively. Regarding QoL survey, 45 patients and 180 controls were enrolled, excluding 8 patients with neurologic impairment. Thirty-seven (82.2%) patients were classified as having a good QoL (score ≥ 9 points); whereas six had a fair QoL (5–8 points) and two had a poor QoL (< 5 points). QoL score in the cases and the controls were 10.2 ± 2.5 and 11.9 ± 0.4 points, respectively. Long aganglionosis form of HD was significantly associated with a low QoL (score < 8 points), adjusted odds ratio = 9, 95% confidence interval [1.3; 64.1] (p < 0.05). In subscales analyses, the prevalence of each dimension including fecal continence, school absenteeism, unhappiness or anxiety, food restriction, and peer rejection was significantly higher in operated patients than in controls (p <0.001). Conclusion Although the QoL of patients operated on for HD in general was with good outcomes, fecal incontinence and constipation still are problematic issues and challenges in a high percentage of patients. Therefore, a long-term and multidisciplinary follow-up is essentially required for these patients.

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Anorectal Dysfunction in Multiple Sclerosis: A Systematic Review

ISRN Neurology ◽

10.5402/2012/376023 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 22

Author(s):

Sanober Nusrat ◽

Elsie Gulick ◽

David Levinthal ◽

Klaus Bielefeldt

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Fecal Incontinence ◽

English Language ◽

Controlled Trial ◽

Neuromuscular Diseases ◽

Anorectal Dysfunction ◽

Pubmed Database ◽

Marginal Improvement

Constipation and fecal incontinence are common in patients with neuromuscular diseases. Despite their high prevalence and potential impact on overall quality of life, few studies have addressed anorectal dysfunction in patients with multiple sclerosis (MS). The goal of this paper is to define the prevalence, pathophysiology, impact, and potential treatment of constipation and incontinence in MS patients. Methods. The PubMed database was searched for English language publications between January 1973 and December 2011. Articles were reviewed to assess the definition of the study population, duration, type and severity of MS, sex distribution, prevalence, impact, results of physiologic testing, and treatments. Results. The reported prevalence of constipation and fecal incontinence ranged around 40%. Anorectal dysfunction significantly affected patients with nearly 1 in 6 patients limiting social activities or even quitting work due to symptoms. Caregivers listed toileting as a common and significant burden. The only randomized controlled trial showed a marginal improvement of constipation with abdominal massage. All other reports lacked control interventions and only demonstrated improvement in individuals with milder symptoms. Conclusion. Anorectal dysfunction is a common manifestation in MS that significantly affects quality of life. Therapies are at best moderately effective and often cumbersome, highlighting the need for simple and more helpful interventions.

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Incorporating a Quality of Life and Well-Being Instrument as an Additional Outcome Measure of a Comprehensive Weight Management Program

Journal of the American Dietetic Association ◽

10.1016/s0002-8223(97)00691-3 ◽

1997 ◽

Vol 97 (9) ◽

pp. A108 ◽

Cited By ~ 1

Author(s):

D.C. Smith ◽

C.S. Robinson ◽

E.F. Myers

Keyword(s):

Quality Of Life ◽

Weight Management ◽

Outcome Measure ◽

Well Being ◽

Management Program ◽

Weight Management Program

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Novos tratamentos para a incontinência anal: injeção de silicone melhora a qualidade de vida em 35 pacientes incontinentes

Revista Brasileira de Coloproctologia ◽

10.1590/s0101-98802007000200006 ◽

2007 ◽

Vol 27 (2) ◽

pp. 167-173 ◽

Cited By ~ 3

Author(s):

Lucia de Oliveira ◽

José Marcio Neves Jorge ◽

Sonia Yusuf ◽

Angelita Habr-Gama ◽

Desidério Kiss ◽

...

Keyword(s):

Quality Of Life ◽

Fecal Incontinence ◽

Scoring System ◽

Cleveland Clinic

Demonstrar através do índice de incontinência e de um instrumento de qualidade de vida, o benefício da utilização do silicone como substância de preenchimento para o tratamento da incontinência anal. 35 pacientes incontinentes foram avaliados através do índice de incontinência (Cleveland Clinic Florida Scoring System-CCFSS) e instrumento de qualidade de vida (Fecal Incontinence Quality of Life-FIQL), antes e após injeção ambulatorial trans-esfincteriana de silicone. Os critérios de inclusão foram: incontinência anal associada a defeito simples do esfíncter interno ou associado a pequeno defeito do esfíncter externo em quadrante anterior. A escala de qualidade de vida avaliada inclui quatro domínios: depressão, estilo de vida, comportamento e constrangimento. Após 3 meses de tratamento, todos os pacientes foram reavaliados através do índice de incontinência e instrumento de qualidade de vida. Os resultados foram analisados estatisticamente através do programa GraphPd Instat. 28 mulheres e 7 homens com idade média de 60,3 (19-80) anos foram submetidos a injeção de silicone para o tratamento de incontinência anal. O índice médio de incontinência, antes e após a injeção, foi de 11,3 e 4,3 (p<0.001). Em relação às alterações na escala de qualidade de vida, notamos significantes alterações em todos os domínios estudados antes e após a injeção: (1) estilo de vida p<0,0001;(2)comportamento p<0,0001;(3) depressão p<0,0001; (4) constrangimento p<0,0001. Em casos selecionados, a injeção trans-esfincteriana de silicone proporciona uma melhora do quadro de incontinência anal, observada pela mudança significativa dos parâmetros do índice de incontinência e instrumento de qualidade de vida.

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