When treating children with fecal incontinence or severe constipation, a common error is not using daily abdominal radiographs to evaluate the efficacy of treatment. When done correctly, daily radiographs provide important details to inform treatment changes for pediatric bowel management. Andrea Bischoff, MD, Co-Director of the International Center for Colorectal and Urogenital Care at Children’s Hospital Colorado, explains the approach her team uses.
Every month, the Center takes one week to address bowel management in children with conditions such as anorectal malformations, idiopathic constipation, Hirschsprung disease and spina bifida. The team administers daily enemas for fecal incontinence or daily stimulant laxatives for severe constipation. Based on daily radiographic findings and how they change daily with treatment, the team uses trial and error to establish the right “recipe” for each individual patient. For example, in a patient taking laxatives for severe constipation, the amount of stool in the rectum and colon should not increase from one day to the other. If it does, the dose should be adjusted. In fecal incontinence, if the radiograph confirms that the rectum and left colon are clean, then treatment is effective. If not, then the team adjusts the recipe based on the amount and location of stool.
Dr. Bischoff emphasizes that the physician ordering the radiographs must provide detailed notes about diagnosis, treatment modality and intention to compare daily radiographs. The radiologist should provide details on each part of the colorectal system in the report. When pediatric colorectal physicians and radiologists clearly communicate these important details, they can better manage pediatric bowel health.
Learn more about the International Center for Colorectal and Urogenital Care at Children’s Hospital Colorado: www.childrenscolorado.org/doc...
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