Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele

Details

• Alternative Title:
  J Pediatr Rehabil Med
• Personal Author:
  Kelly, Maryellen S. ; Wiener, John S. ; Liu, Tiebin ; Patel, Priya ; Castillo, Heidi ; Castillo, Jonathan ; Dicianno, Brad E. ; Jasien, Joan ; Peterson, Paula ; Routh, Jonathan C. ; Sawin, Kathleen ; Sherburne, Eileen ; Smith, Kathryn ; Taha, Asma ; Worley, Gordon
• Description:
  PURPOSE:
  
  Neurogenic bowel dysfunction (NBD) is a common comorbidity of myelomeningocele (MMC), the most common and severe form of spina bifida. The National Spina Bifida Patient Registry (NSBPR) is a research collaboration between the CDC and Spina Bifida Clinics. Fecal continence (continence) outcomes for common treatment modalities for NBD have not been described in a large sample of individuals with MMC. NSBPR patients with MMC and NBD were studied to determine variation in continence status and their ability to perform their treatment independently according to treatment modality and individual characteristics.
  
  METHODS:
  
  Continence was defined as < 1 episode of incontinence per month. Eleven common treatments were evaluated. Inclusion criteria were established diagnoses of both MMC and NBD, as well as age ≥ 5 years (n = 3670). Chi-square or exact statistical tests were used for bivariate analyses. Logistic regression models were used to estimate the odds of continence outcomes by age, sex, race/ethnicity, level of motor function, and insurance status.
  
  RESULTS:
  
  At total of 3670 members of the NSBPR met inclusion criteria between November 2013 and December 2017. Overall prevalence of continence was 45%. Prevalence ranged from 40–69% across different treatments. Among continent individuals, 60% achieved continence without surgery. Antegrade enemas were the most commonly used treatment and had the highest associated continence rate. Ability to carry out a treatment independently increased with age. Multivariable logistic regression showed significantly higher odds of continence among individuals aged ≥ 12 years, female, non-Hispanic white, and with private insurance.
  
  CONCLUSIONS:
  
  The prevalence of continence was generally low and varied between treatment modalities. Better treatment algorithms considering patient factors may result in improved outcomes.
  
  
• Subjects:
  Adolescent Adult Child Child, Preschool Enema Fecal Incontinence Female Humans Male Meningomyelocele Neurogenic Bowel Physical Stimulation Suppositories Treatment Outcome Young Adult

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• Keywords:
  Fecal Incontinence National Spina Bifida Patient Registry Neurogenic Bowel Spina Bifida
• Source:
  J Pediatr Rehabil Med. 13(4):685-693
• Pubmed ID:
  33325404
• Pubmed Central ID:
  PMC8776357
• Document Type:
  Journal Article
• Funding:
  U01DD001065/ACL/ACL HHSUnited States/ ; U01DD001080/ACL/ACL HHSUnited States/ ; U01 DD001278/DD/NCBDD CDC HHSUnited States/ ; U01DD001082/ACL/ACL HHSUnited States/ ; U01DD001069/ACL/ACL HHSUnited States/ ; U01DD001073/ACL/ACL HHSUnited States/ ; U01DD001063/ACL/ACL HHSUnited States/ ; U01 DD001263/DD/NCBDD CDC HHSUnited States/ ; U01 DD001074/DD/NCBDD CDC HHSUnited States/ ; U01 DD001082/DD/NCBDD CDC HHSUnited States/ ; U01DD001071/ACL/ACL HHSUnited States/ ; U01DD001062/ACL/ACL HHSUnited States/ ; U01 DD001265/DD/NCBDD CDC HHSUnited States/ ; U01DD001078/ACL/ACL HHSUnited States/
• Volume:
  13
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:7212d9ffdaba875facefb07abfc48bad1fb4691afb2a528aca536467395a27f2
• Download URL:
  https://stacks.cdc.gov/view/cdc/113684/cdc_113684_DS1.pdf
• File Type:
  [PDF - 475.88 KB ]