Irrigação Transanal simplificada em pacinetes com mielomeningocele e incontinência fecal: resultados funcionais e impacto na qualidade de vida

Abstract

Myelomeningocele (MMC) is the most common and severe open spina bifida. After birth, this malformation can lead to functional disorders such as constipation and anal incontinence, causing a negative impact on the quality of life of patients and their familymembers/caregivers. Transanal irrigation (TAI) has been used successfully in the management of these disorders, howevwe, the device used Peristeen® is not available in Brazil. Aims: To evaluate the viability of simplified Transanal Irrigation (TAI) with the device used for irrigation via colostomy in patients with MMC and fecal incontinence (FI), its impact on the evacuation function, in the quality of life of patients and family members/caregivers. Method: Patients with a confirmed diagnosis of MMC, with defecatory dysfunction characterized by constipation and recurrent IF who did not respond to conservative approaches, such as diet, pharmacological treatments, physiotherapy, were selected for simplified TAI therapy. Patients and their families participated in face-to-face and individual training to learn the technique and develop skills for daily use at home. Validated questionnaires were applied before and after treatment to assess the severity and frequency of incontinence (WexnerScore), quality of life of children and/or adolescents (CHQ-PF50) and adults (FIQL). Specific research questionnaires were also applied that measured the impact of intestinal function on the quality of life of patients and family members/caregivers, as well as the monitoring of the simplified TAI technique. Results: 23 pacients with MMC´s with constipation and fecal incontinence were studied. Daily involuntary defecation was reported by 60,9% of patients, 52,2% had a feeling of incomplete bowel movement and 47,8% used laxatives. The adaptation of the colostomy irrigation kit via transanal proved to be effective, since 100% of the patients and / or family caregivers were able to handle it easily and independently, with no complications reported during the follow-up. At the end of one year, there was a significant decrease in the rate of anal incontinence from 13,96 to 6,83; 87% of patients already had daily defecation and only one patient (4,3%) had daily losses and feeling of incomplete evacuation, after one year of simplified TAI; 82,6% no longer used laxatives. 82,6% reported maximum improvement in quality of life after one year of simplified TAI. Family members/caregivers also reported improved quality of life with regard to tiredness and enjoying life. Conclusions: the simplified TAI, using a colostomy device proved to be an effective method with adequate home handling and significant improvement in intestinal function. As a consequence, patients with MMC and their family/caregivers had a positive impact in their quality of life.