Decision-Making for a Successful Bowel Continence Program

Summary Bowel continence is one of the most difficult challenges for pa tients with spina bifida. Incontinence acts as a social stigma for children and a barrier for adults seeking employment. We present an algorithm for stepwise decision-making in construction of per sonalized continence programs for greater Iikelihood of success. The protocol contains 13 assessment points including; stool con sistency, frequency and amount; mobility; level of paraplegia: diet; medication; anal/rectal canal tone; prior programs at tempted; family routines; age; accessibility; and learning issues. Based on outcomes of these assessments, an individualized bowel program is constructed. The algorithm helps the practitioner and patient decide on components and indicators of a successful con tinence program. The recommended program might include timed toileting, suppo sitory, continence enema, and ACE procedure, or a combination. Evaluation and patient education address adequate fluid/fiber, appropriate toileting equipment, and use of stool softeners/laxa tives. Descriptions are available. Key elements in monitoring a continuing plan for continence in c1ude: the degree of constipation and its etiology; changing age; family availability for assistance until interdependence is optimal; wheelchair accessibility of the toilet; and ability to transfer to and from the toilet. Use of the algorithm allows for careful decision-making based on information from the patient and family. This has led to greater success in bowel continence in children with spina bifida.