Aim: Assess the impact of an innovative children’s anorectal physiology service (CAPS) and weekly specialist multi-disciplinary team (MDT) focusing on improving outcomes in children with chronic constipation (CC) and faecal incontinence (FI).
Methods: prospective data collected on all patients: age, sex, symptoms, co-morbidities, satisfaction. Bowel assessments (St Mark’s Incontinence Score [SMIC], Cleveland Constipation Score [CCS]). Diagnostics: awake high resolution anorectal manometry (AHRAM), endoanal ultrasound and transit marker studies (TMS). Psychosocial assessment undertaken. Referrals and management discussed in MDT.
Results: 112 patients (112/137 (82%) assessed. 66 male (59%); median 9 years (17 months to 16 years). 99 (88%) patients had functional CC/FI, 10 (9%) Hirschsprungs disease, 11 (10%) anorectal malformation and 3 (3%) trauma. SMIC abnormal in 91 (81%) and CCS in 101 (90%). All patients had anorectal physiology: 94 (84%) awake and 18 (17%) under anaesthesia (combined with surgical procedure). Health play specialist input 37 (33%) patients. AHRAM abnormal 65 (58%): sphincter dysfunction 36 (32%) and altered sensation, tested in awake patients only (hyposensitive rectum 22% (20/91) [RH-]; 21% (19/91) hypersensitive rectum [RH+]). TMS normal in 64 (57%), 17 (15%) slow transit and 27 (24%) rectal evacuatory disorder. 55% patients with normal TMS had abnormal physiology. Risk of distress in 38% and poor quality of life in 55%, correlated with school difficulties (p = 0.04). Abnormal SMIC scores correlated with poor quality of life (p=0.02). Management was multimodal in 40% (toileting/medical modification, surgery, irrigation, biofeedback, interpshincteric botox, psychological and neuromodulation). RH- patients predominantly treated with transanal irrigation and RH+ with toileting/medical modification, interpshincteric botox and psychological input. Patient/parent satisfaction with their management improved significantly (p= 0.05).