pain with bowel movements.
production of large stools that can block the toilet.
all of the above.
duration of symptoms.
number of bowel movements per week.
Increase in fluid intake
Polyethylene glycol (PEG)
All of the above
Onset after diet change
Early age of onset (before toilet training)
Presence of a palpable mass in the left lower quadrant
Poor dietary habits ("picky eater")
Digital rectal exam
Lower extremity muscle tone and reflexes
Height and weight
Inspection of the lower back
Visual inspection of the perineum
Open surgical intervention carries a higher success rate than laparoscopic or percutaneous procedures.
Access for antegrade irrigations should be limited to the cecum.
All of the above.
Similar success rates can be expected irrespective of the underlying pathology.
Malone antegrade continence enema (MACE) channels and C-tubes provide better procedural independence than retrograde enemas for patients with neuropathic bowel dysfunction.
direct softening of stools to facilitate passage during the day.
washout with regular evacuation of the entire colon.
decrease sphincter tone.
decrease colon motility.
colonic transit time studies
magnetic resonance imaging (MRI) of lumbosacral spine
contrast enema study
The appendix may be of sufficient length to be split in order to create a MACE and Mitrofanoff channel for neuropathic bowel and bladder management.
Previous surgical interventions are a contraindication for a laparoscopic approach.
An aggressive bowel washout and mechanical preparation is always warranted before surgery.
Presence of a ventriculoperitoneal shunt is a contraindication for laparoscopic approach.
An antireflux mechanism (cecal wrap) is always required in order to prevent stool leakage.
The most common problem is stenosis and difficulty accessing for fluid instillation.
It is difficult to remove or convert to a MACE channel.
It is a good alternative for patients who have previously undergone an appendectomy.
It avoids the need for regular instrumentation.
It is a great alternative for families who have problems with compliance.
Trial and error for more than 6 months may be warranted to reach a reliable enema routine.
Sterile saline is preferred versus tap water or "home-made" saline solution.
Early morning irrigations are preferable as it allows the patients to enjoy better daytime continence.
Daily enemas are universally required to achieve continence.
None of the above
Milk of magnesia
recurrence despite recommendations consistent with optimal medical management.
episodes of bowel obstruction.
alternating constipation and diarrhea.
Difficulty having bowel movements
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