Outpatient Specialty Care Clinical Pathway for Evaluation/Management
of Neurogenic Bowel Dysfunction in Children with Spina Bifida

Symptoms Consistent with Ineffective Bowel Management
Bowel Management Program and Escalation Plan
  • Optimal fiber and fluids before escalation of treatment
  • Avoidance of Trigger Foods
  • Adherence to current program, Tips
  Medication Escalation Plan Comments/Considerations
Infants > 6 Months/ Toddlers
  • Step 1. Polyethylene glycol (PEG 3350)
  • Step 2. Polyethylene glycol (PEG 3350)
  • Step 3. Polyethylene glycol (PEG 3350) + Mini Liquid Glycerin suppository and/or Mini Docusate Enema
  • Step 4. Polyethylene glycol (PEG 3350) + Mini Enema + Senna
  • Allow at least 2 weeks after treatment initiation to assess response.
  • Maximize each prior to discontinuing and initiating next medication.
  • When ready for social continence:
  • Step 1. Cone Enema +/- Polyethylene glycol (PEG 3350)
  • Step 2. Balloon Catheter or Peristeen® +/- Polyethylene glycol (PEG 3350)
  Surgical Alternatives Comments/Considerations
  • Cecostomy
  • Antegrade Continence Enema (ACE/MACE)
  • Colostomy
Patient Education and Follow-Up Recommendations
  • Discharge Education, AVS
    • 0-1 year of age    Every 3 months
    • 1-5 years of age    Every 6 months
    • 5 years of age/older    Every Year
  • Encourage patients to call with any changes in bowel function
Posted: December 2019
Authors: J. Kerr DNP; D. Nicholson DO; M. Magnusson MD; D. Amico RN; J. Melchionni RN; S. Zderic MD; M. Allukian MD; J. Webster DO; S. Borowicz RD