Bowel function and care: Guidelines for the care of people with spina bifida.
Patricia Beierwaltes, Paige Church, Tiffany Gordon and 1 others
PMID 33252093WHAT IT FOUND
Consensus guidelines recommend a stepwise approach to bowel management in spina bifida, starting with diet and fluids before moving to medications or surgery.
The goal is social continence without constipation, tailored to the patient's age and abilities.
Key findings
01The guidelines advocate for a stepwise approach to treatment, moving from least to most invasive options to achieve continence without constipation.
02Initial management focuses on dietary changes (fiber and fluids) and timed bowel movements, with pharmacologic or rectal interventions considered only if these fail.
03Bowel programs must be individualized based on the patient's mobility, cognitive development, and social comorbidities to be successful.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The guidelines are based on expert consensus and existing literature, not on new primary research or clinical trials conducted by the authors. The authors note that there is a lack of robust clinical, translational, and basic science research in neurogenic bowel in children with spina bifida. There is no standardized definition of bowel success, which limits the ability to compare outcomes across different studies and practices. The guidelines do not provide evidence for the efficacy of specific interventions relative to one another, as large-scale randomized controlled trials are lacking.
The easy way to misread this
Do not interpret these guidelines as evidence that specific bowel interventions, such as MACE or transanal irrigation, are proven to be more effective than others. The recommendations are based on expert consensus and a stepwise logic, not on head-to-head trials demonstrating superiority of one method over another.