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
Assure
  • Optimal fiber and fluids before escalation of treatment
  • Avoidance of Trigger Foods
  • Adherence to current program, Tips
Age Medication Escalation Plan Comments/Considerations
Infants > 6 Months/ Toddlers
  • Step 1: Lactulose
  • 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.
Children/Adolescents
  • When ready for social continence:
  •  
  • Step 1: Cone Enema +/- Polyethylene glycol (PEG 3350)
  • Step 2: Balloon Catheter or Peristeen®/Navina® +/- Polyethylene glycol (PEG 3350)
  Surgical Alternatives Comments/Considerations
Children/Adolescents
  • 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 parent/child to call with any changes in bowel function
Posted: December 2019
Revised: October 2022
Authors: J. Kerr, DNP; M. Magnusson, MD; D. D'Amico, RN; S. Zderic, MD; M. Allukian, MD; D. Nicholson, MD; J. Webster DO