BOWEL PROBLEMS AFTER ENTEROCYSTOPLASTY

Objectives To document the changes in bowel habit in patients who have undergone enterocystoplasty. Patients and methods Sixty-nine patients with neuropathic (NP) and 44 with non-neuropathic (NNP) bladder dysfu nction (mean age 26 years, range 13-61, 93.6% socially continent), fol lowed for at least 36 months after cystoplasty, were assessed using a questionnaire addressing faecal frequency, consistency, method of evac uation and incontinence episodes before and after surgery. Results Of the patients with NP bladder dysfunction, 26 (38%) had more and seven (10%) less frequent bowel action after surgery, with 36 (52%) unchange d; 38 (55%) of patients had unchanged consistency, 26 (38%) were loose r and five (7%) more constipated; 41 (59%) opened their bowels as befo re, 16 (23%) needed more help and 12 (17%) less help to evacuate; 16 ( 23%) patients had more and 17 (25%) less episodes of incontinence; 21 (30%) patients felt their bowels had not become normal after their ope ration and only 24 (35%) that they had returned to normal within 3 mon ths of their operation. The bowel segment used was ileum in 44 patient s, ileocaecal in 11 and sigmoid cystoplasty in 14. Patients with intac t ileum did not have the same degree of diarrhoea, with only three of the 14 patients with a sigmoid cystoplasty being adversely affected. O f the patients with NNP bladder dysfunction, 18 patients (41%) had a m ore and five (11%) a less frequent bowel action; 20 (46%) had more loo se and five (11%) less loose bowel action; similar numbers (five and f our) needed either an increase or a decrease in laxatives or enemata; surprisingly, 12 patients (27%) felt they had an increase in the episo des of incontinence; 17 (39%) patients felt their bowels returned to n ormal within 3 months of surgery and 30% felt their bowels had not bec ome normal after surgery. Only one patient in this group had a sigmoid cystoplasty and she did not find that the operation interfered with h er bowel function. Conclusions Ileal resection results in malabsorptio n of bile acids, maldigestion of fat and an imbalance of water and ele ctrolytes. Patients with neurogenic bladders are finely balanced betwe en acceptable bowel function and chaos, and surgery often tips this ba lance the wrong way. In 30% of the present: patients, bowel problems p ersisted after surgery, with 38% having increased frequency, 38% havin g looser consistency and 23% more incontinence episodes following surg ery. More surprisingly, a high percentage of NNP patients had bowel pr oblems after cystoplasty.