TRANSRECTAL ELECTROSTIMULATION THERAPY FOR NEUROPATHIC BOWEL DYSFUNCTION IN CHILDREN WITH MYELOMENINGOCELE

Purpose: We attempted to evaluate the efficacy of transrectal bowel st imulation for neurogenic bowel dysfunction in children with myelodyspl asia. Materials and Methods: Daily sessions of transrectal electrostim ulation were performed on an outpatient basis for 2 to 3 weeks on chil dren with myelodysplasia and stool incontinence. If benefits were note d, 5 to 10 additional daily sessions were performed. Complete success was defined as improvement in all parameters of interest, including de crease in the frequency of daily bowel movements, increased sensation, increased ability to hold stool and a significant subjective change i n bowel habits. Moderate success implied improvement in 1 to 3 paramet ers and treatment failure was defined as lack of improvement in any pa rameter. Results: A total of 55 children 2 to 14 years old (mean age 6 .7) completed a mean of 18 daily sessions per patient of bowel electro stimulation. Followup ranged from 1 to 6 years. Diapers are no longer required due to defecation problems in 14 children older than 3 years. Complete success was achieved in 20 cases (36.3%) and moderate succes s in an additional 30 (54.5%, overall success rate 90.8%). Specificall y, 89% of the patients reported elimination of stooling accidents, 82% reported increased sensation and 71% were able to hold the bowel move ment. Overall 68% of the patients noticed significantly improved bowel function. Complete/moderate success of transrectal electrostimulation was statistically significant for all 4 parameters (p <0.05), and com plete success was significant for increased sensation, ability to hold and episodes of accidents. Therapy failed in 5 children (9%). There w ere no untoward effects. Conclusions: Transrectal electrostimulation i s a well tolerated and minimally invasive modality that provides susta inable improvement in stool continence in children with myelomeningoce le and neuropathic bowel dysfunction.