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Neurogenic Bowel Management, Spina Bifida — History — Clinical Pathway: Outpatient Specialty Care

Neurogenic Bowel Management, Spina Bifida Clinical Pathway — Outpatient Specialty Care

Patient with Spina Bifida and Neurogenic Bowel Dysfunction

A thorough history and physical exam can distinguish Neurogenic Bowel Dysfunction from an alternative diagnosis and helps to guide individualized treatment.

History and Physical

History General
  • Age at first passage of meconium
  • Frequency of stools
  • Consistency of stools, Bristol Stool Scale (BSS)
  • Bowel accidents (children and adolescents)
  • Spinal function level, ambulation
  • Recent illness
  • Recent surgery
  • Recent travel
Toilet-Training Behavior
  • Sensation of imminent bowel movement
  • Hiding during bowel movements (toddlers)
  • Valsalva during bowel movements
Symptoms
  • Abdominal pain
  • Nausea, vomiting
  • Recurrent UTIs
  • Blood in stool or on toilet paper
Dietary History
  • Breastfed vs. formula (ensure proper mixing of formula)
  • Loss of appetite
  • Fiber intake
  • Fluid intake
  • Trigger foods (dairy, fried food, fast food, sugary drinks)
Treatment
  • Previous and present treatment including over-the-counter medications and home remedies
Physical Exam Abdomen
  • Distension, fecal mass, tenderness
  • Surgical scars
Anus
  • Position of anus
  • Patulous vs. competent
  • Absence or presence of anal wink
  • Digital rectal exam to assess for anal tone and hard stool in vault
  • Rectal prolapse
 
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