Effectiveness of the bowel management program in children with constipation secondary to anorectal malformation

Resumen

Introduction: in Mexico, approximately 1 000 children each year are born with anorectal malformation (ARM). Despite surgical correction, those children present fecal function problems (60-70% have difficult to manage constipation). A Bowel Management Program (BMP) was implemented, which consists of initial rectal disimpaction, followed by administration of a stimulant laxative (sennosides), with favorable results. The objective of this study was to describe the effectiveness of
the BMP in children with constipation secondary to ARM.

Material and methods: A descriptive, retrospective, transverse study to answer the question: how effective is the BMP in children with constipation secondary to ARM? Efficacy was evaluated by means of a construct with three variables (daily fecal evacuations, absence of fecal staining, and simple abdominal x-ray without fecal residue in rectum and left colon after evacuation). All children with surgically corrected ARM and constipation from two national referral centers for children
with the condition were included.

Results: of 151 children with ARM monitored in outpatient service, only 67.33% had constipation. Of this group, 88.1% showed good response to the BMP. The average dose of sennoside was 8.45 mg/kg, 95% CI: 5.94-11.12 mg/kg (199.5 mg total dose; 95% CI: 139.50-259.50 mg). Abdominal cramp was the primary adverse effect reported (5.8%).

Discussion: use of sennosides had a positive impact on our patients’ quality of life by achieving colonic and rectal emptying and preventing daily fecal staining.