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

The data were cross-sectional, so the study could not show that a treatment caused continence or determine how long someone had used it. Continence was based on registry reports collected by different methods, and the registry did not capture constipation, episode quantity, or satisfaction. People using pouch diversion, ileostomy, or colostomy were excluded from continence analyses, so results do not describe all bowel management options. The registry enrolled selected multidisciplinary centers of excellence, so results may not apply to people who attend other clinics or no specialized clinic. Comparisons between treatments were not randomized or rigorous, and people using more invasive methods may have failed less invasive methods first.

The study used the National Spina Bifida Patient Registry funded by the CDC, and several authors were funded investigators on that registry. One author served on an advisory board for Coloplast Corp., the manufacturer of Peristeen transanal irrigation, and received an honorarium from that company.

Do not read the higher continence rate with antegrade enemas as proof that the treatment causes continence. The study used cross-sectional registry data, and the authors state their findings do not imply a causal connection.