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689 Combination trans-anal irrigation package improves treatment compliance in children with intractable constipation and faecal incontinence

Archives of disease in childhood, 2022-08, Vol.107 (Suppl 2), p.A109-A109 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. ;2022 Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 0003-9888 ;EISSN: 1468-2044 ;DOI: 10.1136/archdischild-2022-rcpch.177

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  • Title:
    689 Combination trans-anal irrigation package improves treatment compliance in children with intractable constipation and faecal incontinence
  • Author: Menakaya, Jide ; Giles, Christine ; Williams, Alison ; Chandran, Anchit
  • Subjects: Abstracts ; Children ; Children & youth ; Compliance ; Constipation ; Fecal incontinence ; Irrigation ; Pediatrics ; Quality control
  • Is Part Of: Archives of disease in childhood, 2022-08, Vol.107 (Suppl 2), p.A109-A109
  • Description: AimsConstipation and faecal incontinence is a common distressing symptom affecting about 3% of the childhood population.1. Regular trans-anal irrigation (TAI) has become an established intervention to reduce the impact of this condition on affected children.2 Treatment failure is seen in 5-36% of children.3 As part of a quality improvement programme on the management of childhood constipation and incontinence, we sought to determine the compliance levels for children in whom we offered a combination of high and low volume irrigation packages as part of their multi disciplinary management plan.MethodsWe reviewed the records of 80 children who were referred to a weekly consultant delivered dedicated community based multi disciplinary clinical programme for constipated and encopretic children. 24 children received different modalities of trans-anal irrigation after a structured training programme accompanied with ongoing community nursing support. We used The Qufora Click® System (high volume irrigation) alone, The Qufora MiniGo System® (low volume irrigation) alone or a combination of high and low volume irrigation packages depending on the needs of the child. Children and carers provided progress reports via a secure online platform Qualtrics XM® We analysed patient characteristics, the compliance after 4 weeks of treatment and clinical outcomes in this group of children. We used descriptive and statistical analytical methods to evaluate our data.Results80 children (M:53) were referred to the service. Of these, 25 (M:16) received trans-anal irrigation in addition to other interventions by the multi-disciplinary team designed to improve their care. The average age of the TAI cohort was 10.2±1.4 yr (range 4-18yr). The 25 children all complained of constipation but 23 had faecal incontinence. 17 children (68%) had recorded elevated average Cleveland constipation score of 15.9±4.9 and elevated average St Marks score of 16.9±2.1. 13 children received high volume TAI alone, 6 children received low volume trans-anal irrigation alone and 6 children received a combination of high and low volume irrigation package. Across the cohort, 9 children have discontinued the use of TAI; 7 because they improved temporarily or permanently and no longer required the treatment, and 2 because they could not tolerate the procedure within the first 4 weeks of treatment. One child in the high volume irrigation group and one child in the low volume irrigation group stopped treatment within 4 weeks of initiating TAI. No child in the combination group has stopped trans-anal irrigation. 18 children continue to use TAI after 4 weeks of treatment to minimise their symptoms. In total, 22 out of 25 children (88%)in the cohort were compliant with their tailored trans-anal irrigation programme over an average follow up period of 18 months (range 1-39) months with improved symptoms.ConclusionFlexible use of trans-anal irrigation packages including a combination of low and high volume irrigation programmes improve compliance with treatment in children with intractable constipation and faecal incontinence.Referencesvan den Berg MM, Benninga MA, et al; Am J Gastroenterol 2006: 101 2401-9.Mosiello G, Marshall D, et al; JPGN 64:3 343-352.Koppen IJN, Kuizenga-Wessel S, et al: JPGN 2017;64:225–9.
  • Publisher: London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
  • Language: English
  • Identifier: ISSN: 0003-9888
    EISSN: 1468-2044
    DOI: 10.1136/archdischild-2022-rcpch.177
  • Source: Alma/SFX Local Collection
    ProQuest Central
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