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Pediatric Surgery International

, Volume 31, Issue 8, pp 765–771 | Cite as

Contrast enema as a guide for senna-based laxatives in managing overflow retentive stool incontinence in pediatrics

  • Ahmed Bassiuony RadwanEmail author
  • Mohammed Soliman El-Debeiky
  • Sameh Abdel-Hay
Original Article

Abstract

Objectives

Overflow retentive stool incontinence (ORSI) is secondary to constipation and fecal loading. In our study, the dose and duration of senna-based laxatives (SBL) treatment to achieve full defecatory control will be examined for possible correlation with new parameters measured from the initial contrast enema.

Methods

Initially, an observational study was conducted prospectively on a group of patient with ORSI to define the optimum dose of SBL to achieve full defecatory control with measurement of six parameters in the initial contrast enema (level of colonic dilatation, recto-anal angle, ratio of maximal diameter of dilated colon to last lumbar spine, ratio of maximum diameter of dilated colon to normal descending colon, immediate and after 24-h post-evacuation residual contrast). The result was analyzed statistically to reach a correlation between the radiological data and prescribed dose.

Results

Over 2 and half years, 72 patients were included in the study; their mean age was 6.3 ± 3.33 years. The mean effective starting dose of SBL was 57 ± 18.13 mg/day and the mean effective ending dose was 75 ± 31.68 mg/day. Time lapsed till full defecatory control ranged from 1 to 16 weeks. Statistical correlation revealed that mean effective ending dose of SBL treatment significantly increased with higher levels of colonic dilatation. A weak positive correlation was found for both the mean effective starting and ending doses with the ratio of maximum colonic diameter to last lumbar spine and descending colonic diameters ratio.

Conclusion

Senna-based laxatives are effective treatment for overflow retentive stool incontinence and their doses can be adjusted initially depending on the analysis of the radiological data.

Keywords

Functional constipation Stool incontinence Senna-based laxative Contrast enema 

References

  1. 1.
    Reid JR, Buonomo C, Moreira C et al (2000) The barium enema in constipation: comparison with rectal manometry and biopsy to exclude Hirschsprung’s disease after the neonatal period. Pediatr Radiol 30(10):681–684PubMedCrossRefGoogle Scholar
  2. 2.
    Poenaru D, Roblin N, Bird M et al (1997) The pediatric bowel management clinic: initial results of a multidisciplinary approach to functional constipation in children. J Pediatr Surg 32(6):843–848PubMedCrossRefGoogle Scholar
  3. 3.
    King SK, Sutcliffe JR, Southwell BR et al (2005) The antegrade continence enema successfully treats idiopathic slow-transit constipation. J Pediatr Surg 40:1935–1940PubMedCrossRefGoogle Scholar
  4. 4.
    Singh SJ, Gibbons NJ, Vincent MV et al (2005) Use of pelvic ultrasound in the diagnosis of megarectum in children with constipation. J Pediatr Surg 40:1941–1944PubMedCrossRefGoogle Scholar
  5. 5.
    Simpson BB, Ryan DP, Schnitzer JJ et al (1996) Surgical evaluation and management of refractory constipation in older children. J Pediatr Surg 31(8):1040–1042PubMedCrossRefGoogle Scholar
  6. 6.
    Gillespie MC, Price KJ (2008) The management of chronic constipation. Paediatr Child Health 18(10):435–440CrossRefGoogle Scholar
  7. 7.
    Yik YI, Leong LCY, Hutson JM, Southwell BR (2012) The impact of transcutaneous electrical stimulation therapy on appendicostomy operation rates for children with chronic constipation- a single institution experience. J Pediatr Surg 47:1421–1426PubMedCrossRefGoogle Scholar
  8. 8.
    Tabbers MM, DiLorenzo C, Berger MY et al (2014) Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 58(2):258–274PubMedCrossRefGoogle Scholar
  9. 9.
    O’Mathúna D, Larimore WL (2006) Alternative Medicine, 2nd edn. Zondervan, Grand RapidsGoogle Scholar
  10. 10.
    Mahieu P, Pringot J, Bodart P (1984) Defecography: 1. Description of a new procedure and results in normal patients. Gastrointest Radiol 9(3):247-251PubMedCrossRefGoogle Scholar
  11. 11.
    Levitt MA, Peña A (2010) Fecal incontinence and constipation. In: Holcomb GW III, Murphy JP (eds) Ashcraft’s pediatric surgery, 5th edn. Saunders Elsevier, Philadelphia, pp 491–501CrossRefGoogle Scholar
  12. 12.
    van den Berg MM, Benninga MA, Di Lorenzo C (2006) Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 101:2401–2409PubMedCrossRefGoogle Scholar
  13. 13.
    Wald A, Sigurdsson L (2011) Quality of life in children and adults with constipation. Best Pract Res Cl Ga 25(1):19–27CrossRefGoogle Scholar
  14. 14.
    Procter E, Loader P (2003) A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service. Child Care Health Dev 29:103–109PubMedCrossRefGoogle Scholar
  15. 15.
    Alper A, Pashankar DS (2013) Polyethylene glycol: a game-changer laxative for children. J Pediatr Gastroenterol Nutr 57(2):134–140PubMedCrossRefGoogle Scholar
  16. 16.
    Burgers R, Levin AD, Di Lorenzo C et al (2012) Functional defecation disorders in children: comparing the Rome II with the Rome III criteria. J Pediatr 161(4):615–620PubMedCrossRefGoogle Scholar
  17. 17.
    Levitt MA, Martin CA, Falcone RA, Peña A (2009) Transanal rectosigmoid resection for severe intractable idiopathic constipation. J Pediatr Surg 44:1285–1291PubMedCrossRefGoogle Scholar
  18. 18.
    Loening-Baucke V (2002) Polyethylene glycol without electrolytes for children with constipation and encopresis. J Pediatr Gastroenterol Nutr 34(4):372–377PubMedCrossRefGoogle Scholar
  19. 19.
    Bijoś A, Czerwionka-Szaflarska M, Mazur A et al (2007) The usefulness of ultrasound examination of the bowel as a method of assessment of functional chronic constipation in children. Pediatr Radiol 37:1247–1252PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ahmed Bassiuony Radwan
    • 1
    Email author
  • Mohammed Soliman El-Debeiky
    • 1
  • Sameh Abdel-Hay
    • 1
  1. 1.Pediatric Surgery Department, Faculty of MedicineAin-Shams UniversityCairoEgypt

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