Continence Using a Decision Tree to Guide Bowel Management in Spina Bifida Beierwaltes

Background When born with Spina Bifida, there are numerous neurologic disorders that accompany this birth defect, including neurogenic bowel. Proactive and systematic, rational approaches can lead to continence and a more functional life style (Doolin, 2007). This presentation will include advances in bowel managment options. Methods Based on the evidence in the literature and expert experience, our approach to bowel mangement was recognized to be a step by step, individualized approach. This was converted to a decision tree for easy guidance of treatment decisions. The approach includes teaching patients and families normal bowel function, changes resulting from neurogenic bowel, common pitfalls in bowel management, and tips that may improve outcomes. The decision tree starts with dietary managment, breaks into a two-fold attack, oral and rectal. One clinic from the National Spina Bifida Patient Registry (NSBPR) data was compared to public data from the NSBPR. Results Preliminary data from the National Spina Bifida Patient Registry (NSBPR) in 2011 reported bowel continence in 42.1% (n = 898) compared to our clinic outcomes of 72.1% (n = 43). As the variable of bowel continence has been further defined and further patients were enrolled, the clinic results were comparable to the national reports. Consistency among providers and caregivers is critical to evaluating the management of Spina Bifida. Conclusions This protocol warrants further evaluation but is offered as a rational, step by step, approach to bowel management in Spina Bifida. It includes the most recent tools and techniques as well as basic bowel management.