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 into the bowel. A solution is injected through the catheter into the bowel. The fluid irrigates and flushes out faeces in the bowel through the anus in approx 20 minutes. A variety of fluids can be used (treacle & milk; saline; licorice). This is much easier to do, especially for persons with limited mobility, than inserting a tube up the anus and firing a saline 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.

You can swim and do most other things with the device.

The first procedure of this type was developed jointly by paediatric surgeon Dr. Barry Shandling and interventionist radiologist Dr. Peter Chait.

The first procedure was performed in June 1994 at The Hospital for Sick Children in Toronto. The procedure is now also performed at HealthCare centres in the United States and Interventional Radiologists around the world are now learning the procedure.

The procedure is now widely used in Australia for children with a variety of bowel/constipation problems. It is just starting to be used in spina bifida (at a range of different ages) and the results are quite positive. Be aware that it is not a magic bullet (it doesn’t cure incontinence) and it won’t work on every bowel, however it has the potential to make a huge impact on the bowel as CIC did with bladder incontinence.

Talk to spina bifida associations and doctors/continence nurses at spina bifida clinics for more advice and referral.