Decision-making for a successful bowel continence program

S. Leibold, E. Ekmark, R. C. Adams

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Bowel continence is one of the most difficult challenges for patients with spina bifida. Incontinence acts as a social stigma for children and a barrier for adults seeking employment. We present an algorithm for stepwise decision-making in construction of personalized continence programs for greater likelihood of success. The protocol contains 13 assessment points including; stool consistency, frequency and amount; mobility; level of paraplegia: diet; medication; anal/rectal canal tone; prior programs attempted; family routines; age; accessibility; and learning issues. Based on outcomes of these assessments, an individualized bowel program is constructed. The algorithm helps the practitioner and patient decide on components and indicators of a successful continence program. The recommended program might include timed toileting, suppository, continence enema, and ACE procedure, or a combination. Evaluation and patient education address adequate fluid/fiber, appropriate toileting equipment, and use of stool softeners/laxatives. Descriptions are available. Key elements in monitoring a continuing plan for continence include: the degree of constipation and its etiology; changing age; family availability for assistance until interdependence is optimal; wheelchair accessibility of the toilet; and ability to transfer to and from the toilet. Use of the algorithm allows for careful decision-making based on information from the patient and family. This has led to greater success in bowel continence in children with spina bifida.

Original languageEnglish (US)
Pages (from-to)26-30
Number of pages5
JournalEuropean Journal of Pediatric Surgery, Supplement
Issue number1
StatePublished - Dec 1 2000


  • Bowel continence
  • Neurogenic
  • Spina bifida

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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