2. Sorrento, Italy, October 1-3, 2015
The 7th European Pediatric GI Motility Meeting
Sorrento, Italy, October 1-3, 2015
Efficacy and safety of enemas administered high in the rectum/sigmoid for fecal disimpaction in children.
Marjolijn Landman, nurse practitioner pediatric gastroenterology
Michael Groeneweg, pediatric gastroenterologist

4. Poeppoli Rotterdam Multidisciplinary team
Referral center for children with
functional constipation and/or fecal
incontinence
500 patients / yr

5. City of Rotterdam A R

6. Efficacy and safety of enemas administered high in the rectum/sigmoid for fecal disimpaction in children.
The Procedure

7. The procedure
The child is lying on its left side after explaining the procedure
Rectal canulla: positioned as high as possible
Lidocain ointment
Syringe (60ml)
Olive oil / sweat oil: for softening hard stools (15-20 min.)
Age < 2 yr: 25 ml
Age 2-6 yr: 50 ml
Age > 6 yr: 100 ml
Iriflex waterpump
Tap water (handwarm):
Age < 2 yr: 250 – 500 ml
Age 2-6 yr: ml
Age > 6 yr: 1000 ml
Colex enema (120 ml): sodium phosphate 3,2 grm / monobasic sodium phosphate 13,9 grm

8. Materials used:

9. Practice
Based
procedure

10. No data in literature on effectivity or safety of this procedure in children

11. Study aim How effective is this procedure ?
What are the side effects ?
How safe is it ?

12. Study design Retrospective analysis of all procedures
performed in 2013 and 2014
Effectivity: -- Bristol stool scale (consistancy)
-- the amount of produced stool semi quantitative
-- the number of procedures needed
Side-effects (reported by patients, and observed by nurse)
Safety

13. The patients Indication: fecal impaction:
- functional constipation by ROME III
- evidence of impacted stools:
-- palpable in the abdomen
-- by rectal examination

14. Consistancy of stools produced

15. Method to estimate the amount of stools produced
No production 12 hrs after enema
Small amount defined as: far less then expected for the age of the child
Normal amount of stools normal for the age of the child
Large amount of stools defined as: at least twice the amount expected for the age of the child
Normal or Large amount and feeling releaved = succes

16. Results Charts of 123 procedures were evaluated
N=77 all data were documented, performed in 75 children
36 girls / 39 boys
Mean age 9,8 yr (3,6 – 19)
25 (30 %) children needed more than 1 procedure

17. Stool consistancy: Bristol Stool Scale

18. Stool consistancy: Bristol Stool Scale
Bristol 1 - 4: N=37 procedures
Bristol 5 - 7: N=40 procedures
Combinations of two Bristol types: N=16
N=14 of these combination of at least Bristol 5-7
Softening of stools in the large majority of patients

19. The amount of stools produced

20. Side-effects during and after procedure:
abdominal pain cramps especially when water is pumped in
significant anxiety: 20% (15 procedures)
with impact on performance of procedure, NOT on effectivity
no procedure-related complications

21. Conclusions
This method of fecal disimpaction is effective in 68 % of children
32 % of children need a repetitive procedure to get disimpacted:
-- only 2 patients needed 3 procedures
In 1 out of 5 (20%) patients there is considerable anxiety, making hard to fully perform the procedure

23. What can we learn from our study ?
Safe and effective method of disimpaction
Yes, but we cannot mirror our results with studies by others..
Is it better than just a ‘regular’ enemas ?
Is it better than an oral disimpaction scheme ?
…prospective studies needed

24. Poeppoli Rotterdam Ineke Olivier continence nurse
Anne Sofie Pijpers behavioral therapist
Stefanie Lipic behavioral therapist
Els van Everdingen psychologist
Diana van Mechelen endoscopy nurse
Ulcu Bekali endoscopy nurse
Marjolijn Landman nurse practitioner
Jurjen Boes pediatrician
Michael Groeneweg pediatric GE