Predictors of successful transitions in a bowel management program

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BACKGROUND: Bowel management programs (BMPs) have demonstrated effectiveness in treating severe constipation and encopresis. We aimed to evaluate the transition rate from more invasive to less invasive treatments (e.g. enema to laxative therapy) and identify clinical characteristics that increase likelihood of downgrading treatment over time. METHODS: Patients participating in our institution's BMP (2020-2024) were identified. Those without adequate follow-up after BMP induction were excluded. Follow-up was collected at 6-, 12-, 18-, and 24-month clinical visits. 'Downgrade' was defined as a transition from enemas to laxatives or from laxatives to no medications. Success was defined as <2 stool smears/week. A multivariate Cox regression model was used to ascertain the effect size of independent predictors of ability to downgrade. RESULTS: Ninety-eight patients were included (63 % male). Median age was 8.8 years at BMP induction (IQR 5.7-10.9). Functional constipation (74 %), Hirschsprung disease (16 %), and anorectal malformation (7 %) were the most common diagnoses and 33 % had a behavioral diagnosis. 62 % of patients were started on large volume enemas. At a median follow-up of 12.9 months (IQR 6.2-24.6), downgrade occurred in 48 patients (49 %) with a median time to downgrade of 6.2 months (IQR 5.7-11.7). CONCLUSION: Approximately half of patients transitioned to less invasive regimens over two years, with earlier transitions most common among functional constipation. Findings support the effectiveness of structured BMPs and inform counseling on the timing and likelihood of downgrading. LEVEL OF EVIDENCE: IV.

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