Key facts about managing bowel incontinence - Surgery options

What surgical procedures may assist?

There are some options available for you to consider. Of course, you will consult a specialist in order to be advised as to the most suitable procedure for your needs. The most promising development is the Malone procedure which makes it much easier to administer the bowel wash out.

Malone procedure for ante grade (downward) bowel wash out

• The Malone stoma is a new surgical procedure that greatly improves the management of bowel incontinence for people with spina bifida.
• The procedure allows bowel wash outs or enemas to be done in an antegrade manner (flushing downwards) rather than in the traditional retrograde manner (flushing upwards from the anus).
• This works much more effectively and is much easier to self-administer. It supports greater self management, and therefore independence.
• In a very simple procedure, the appendix is brought to the surface of the skin and a stoma (opening on the skin) is created around the bikini line. The stoma allows access to the bowel through the appendix. The stoma has a little plastic trapdoor inserted in it that opens and closes.
• A catheter is placed into the stoma and into the bowel. A solution is injected through the catheter into the bowel. The fluid irrigates and flushes out stools in the bowel through the anus in approximately 20 minutes.
• A variety of fluids can be used (treacle and milk; saline; liquorice).
• This is much easier to do, especially for persons with limited mobility, than inserting a tube up the anus and firing a solution upwards against the force of gravity.
• Sometimes the stoma is created directly into the bowel. It has even been done through the belly button.
• The procedure is reversible, ie. if it doesn’t work, the trapdoor is removed and the stoma grows over.
• Quality of life is improved. You can swim and do most other things with the device.
• The procedure is just starting to be used in spina bifida (at a range of different ages) and the results are positive.
• Be aware that it is not a magic bullet (it doesn’t cure incontinence) and it won’t work for everyone.
• Talk to spina bifida associations and doctors/continence nurses at spina bifida clinics for more advice and referral.