Cincinnati Children's Hospital Colorectal Center for Children, Cincinnati, OH, United States.
Clinical Child Psychology Program & Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, United States.
J Pediatr Surg. 2021 Aug;56(8):1459-1464. doi: 10.1016/j.jpedsurg.2021.04.025. Epub 2021 Jun 5.
Severe fecal incontinence (FI) is common in patients both with and without anorectal malformations. Whether a formal bowel management program (BMP) has significant effects on FI, psychosocial development of the child, and caregiver stress is poorly understood. We hypothesize that BMP participation results in long-term clinical and quality of life (QOL) improvements for patients and caregivers.
Using a prospective cohort study over three years, 342 children (age 3-12 years) and caregivers were followed for one year after attending a week-long BMP, during which a regimen was tailored to promote daily stool evacuation.FI QOL was measured with the validated Cincinnati Fecal Incontinence Scale (CINCY-FIS), evaluating multiple subscales, including parental stress. Scores were obtained at multiple timepoints following BMP (baseline, 2 weeks, 3 months, 1 year).
Within 2 weeks, BMP participation significantly improved FI with increased frequency of daily daytime voluntary bowel movements (20%-70%, p < 0.001) and decreased daily daytime and nighttimeinvoluntary bowel movements (60%-20%, p < 0.001; 30%-10%, p < 0.05). Marked improvements in CINCY-FIS were observed across multiple QOL subscales, with the greatest in parental stress, and sustained through one year.
BMP results in significant and sustained improvement in FI and QOL for patients and caregivers.
严重的粪便失禁（FI）在患有和不患有肛门直肠畸形的患者中都很常见。是否有正式的肠道管理方案（BMP）对 FI、儿童的心理社会发展和照顾者的压力有显著影响，目前了解甚少。我们假设 BMP 的参与会为患者和照顾者带来长期的临床和生活质量（QOL）改善。
通过为期三年的前瞻性队列研究，对 342 名（年龄 3-12 岁）儿童及其照顾者进行了为期一年的随访，这些儿童在参加为期一周的 BMP 后随访一年，在此期间，根据个人情况制定了促进每日排便的方案。FI 的 QOL 使用经过验证的辛辛那提粪便失禁量表（CINCY-FIS）进行评估，该量表评估了多个子量表，包括父母的压力。在 BMP 之后的多个时间点（基线、2 周、3 个月、1 年）获得分数。
在 2 周内，BMP 参与显著改善了 FI，每日白天的自发性排便频率增加（20%-70%，p<0.001），每日白天和夜间的非自发性排便次数减少（60%-20%，p<0.001；30%-10%，p<0.05）。CINCY-FIS 的多个 QOL 子量表均观察到显著改善，其中父母压力的改善最大，并持续到一年。
BMP 可显著且持续改善患者和照顾者的 FI 和 QOL。
