Rationale for the Radiological Evaluation in Patients Subjected to Medical Management for the Treatment of Fecal Incontinence
After several failed attempts to improve their quality of life, many children suffering from fecal incontinence (the inability to control the bowels voluntarily) are brought to the Colorectal Center at Cincinnati Children's Hospital Medical Center. The Colorectal Center is an international treatment center for colorectal problems, including fecal incontinence following the surgical repair of anorectal malformations.
A specific protocol, the week-long Bowel Management Program, is used at the Colorectal Center to teach parents and other caregivers how to clean the child's colon once a day. A key element of this program is determining by trial and error the ideal type of enema that is capable of cleaning the colon of each individual patient.
In addition, for those patients who suffer from increased colonic motility (rapid movement of food through the colon), we have to find the best possible way to decrease their colonic motility to ensure that the patient's colon stays completely clean 24 hours per day in between enemas. That sometimes involves prescribing a specific constipating diet and/or medications that slow down the colon.
The bowel management program is considered successful once the patient can maintain a clean colon and is able to wear normal underwear all the time. The family and patients continue the program when they return home. After days, weeks, months or years, however, the program may no longer work, either because the enema is no longer cleaning the colon or because the colon is moving too fast due to dietary or other problems.
To readjust the bowel management program without the family having to come back to the Colorectal Center, parents are asked to obtain an X-ray of the abdomen when the patient has accidents (passing stool in the underwear in between enemas). This helps to determine the specific reason why the bowel management is no longer working. For instance, if the X-ray shows a colon with a large amount of stool, we may recommend using a larger enema or one with a more concentrated fluid to better empty the colon. On the other hand, if we see an empty colon, it is conceivable that the patient is suffering from some sort of diarrhea, and we have to prescribe treatment for that condition.
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