Advanced Management Protocol of Transanal Irrigation in Order to Improve the Outcome of Pediatric Patients with Fecal Incontinence

Background: Transanal irrigation (TAI) is employed for children with fecal incontinence, but it can present several problems which require a study of their outcomes among different pathologies and without a tailored work up. The aim of our study was to evaluate the effectiveness of an advanced protocol in order to tailor TAI, prevent complications, and evaluate outcomes. Methods: We included 70 patients (14 anorectal malformation, 12 Hirschsprung’s disease, 24 neurological impairment, 20 functional incontinence) submitted to a comprehensive protocol with Peristeen®: fecal score, volumetric enema, rectal ultrasound, anorectal 3D manometry, and diary for testing and parameter adjustment. Results: Among the patients, 62.9% needed adaptations to the parameters, mainly volume of irrigated water and number of puffs of balloon. These adaptations were positively correlated with pre-treatment manometric and enema data. In each group, the improvement of score was statistically significant in all cases (p 0.000); the main factor influencing the efficacy was the rate of sphincter anomalies. The ARM group had slower improvement than other groups, whereas functional patients had the best response. Conclusions: Our results showed that TAI should not be standardized for all patients, because each one has different peculiarities; evaluation of patients before TAI with rectal ultrasound, enema, and manometry allowed us to tailor the treatment, highlighting different outcomes among various pathologies, thus improving the efficacy

How to Talk About Incontinence: A Checklist

Incontinence is the medical term used to describe the involuntary loss of urine or faeces. Women, men, girls, boys and people of all genders, at any age, can experience incontinence. A person with incontinence can experience leakage occasionally, regularly or constantly; and leakage can happen at any time, day or night. A person may also experience leakage of urinary or faecal matter due to not being able to get to the toilet in time or not wanting to use the toilet facilities available. This is known as social, or functional, incontinence. In many low- and middle-income countries (LMICs) understanding of incontinence is still in its early stages: the term ‘incontinence’ may not be known, knowledge of the condition is rare, and the provision of support is lacking. Those who experience incontinence may face stigma due to having the condition, and this may affect their willingness or confidence to talk about it. There is a need to better understand incontinence in LMICs, and how best to support people living with the condition to improve their quality of life. This requires having conversations with individuals that experience the condition, and with individuals who care for those who do: they will have the lived experiences of what it means to live with incontinence practically, emotionally and socially for them and their families. Living with incontinence can have a range of impacts on the people living with it and their carers. These include increased stress and distress; additional needs for water and soap; and restricted ability to join in community activities, school or work. Living with incontinence can also lead to a range of protection issues. The potential challenges that people face may be quite diverse and may vary between people and households. The checklist below, and corresponding page references to ‘Incontinence: We Need to Talk About Leaks’ can be used to increase your understanding of incontinence and the options available to support people living with the condition; and provide guidance on how to have conversations to understand how best to support people living with incontinence in your area.

How to Talk About Incontinence: A Checklist

Incontinence is the medical term used to describe the involuntary loss of urine or faeces. Women, men, girls, boys and people of all genders, at any age, can experience incontinence. A person with incontinence can experience leakage occasionally, regularly or constantly; and leakage can happen at any time, day or night. A person may also experience leakage of urinary or faecal matter due to not being able to get to the toilet in time or not wanting to use the toilet facilities available. This is known as social, or functional, incontinence. In many low- and middle-income countries (LMICs) understanding of incontinence is still in its early stages: the term ‘incontinence’ may not be known, knowledge of the condition is rare, and the provision of support is lacking. Those who experience incontinence may face stigma due to having the condition, and this may affect their willingness or confidence to talk about it. There is a need to better understand incontinence in LMICs, and how best to support people living with the condition to improve their quality of life. This requires having conversations with individuals that experience the condition, and with individuals who care for those who do: they will have the lived experiences of what it means to live with incontinence practically, emotionally and socially for them and their families. Living with incontinence can have a range of impacts on the people living with it and their carers. These include increased stress and distress; additional needs for water and soap; and restricted ability to join in community activities, school or work. Living with incontinence can also lead to a range of protection issues. The potential challenges that people face may be quite diverse and may vary between people and households. The checklist below, and corresponding page references to ‘Incontinence: We Need to Talk About Leaks’ can be used to increase your understanding of incontinence and the options available to support people living with the condition; and provide guidance on how to have conversations to understand how best to support people living with incontinence in your area.

Urinary incontinence after stroke

‘Urinary incontinence after stroke’ explores the problem of urinary incontinence. It describes the different types of urinary incontinence with a focus on the types of incontinence prevalent after a stroke; the impact of this symptom complex on the psychological state of the patient, mortality, dependency, and institutionalization; the age related changes in the urinary tract; the epidemiology of post-stroke urinary incontinence, risk factors predisposing to it, assessment methods (including bedside assessments), management with identification of transient causes of incontinence, behavioural strategies, pharmacological therapy, treatment of comorbid conditions, and management in special situations. Urge incontinence, stress incontinence, incomplete emptying, functional incontinence, overflow incontinence, and lower urinary tract symptoms, are all discussed in the context of the pathophysiology and management of these conditions.