Development of a Training Program for Promoting Autonomous Bowel Management in Children with Hirschsprung's Disease or Anorectal Malformation

Monday, 22 July 2013

Miyuki Nishida, RN, PhD
Faculty of Health Care and Nursing, Juntendo University, Chiba, Japan

Learning Objective 1: The learner will be able to know development of a program to help children with fecal incontinence.

Learning Objective 2: The learner will be able to know how to be empower ,aoutonomy , self-care to children and mothers.

Purpose: Development of a program to help children with anorectal malformation or Hirschsprung’s disease attain autonomy over defecation.

Methods: The subjects of this study were 15 children with anorectal malformation or Hirschsprung’s disease and their mothers, who participated in a comprehensive training program to promote autonomous bowel management over a 5-year period, the results of which were evaluated by semi-structured interviews and questionnaires.

Ethical considerations: The study was approved by the ethics committee of both the author’s institution and that at which data was collected.

Results: The program consisted primarily of provision of knowledge and emotional support for mother and child. Knowledge scores rose for both mother and child, though not statistically significant. During infancy, mothers noted becoming capable of engaging positively in defecation care following acceptance of the disorder and taking part in the empowerment program. From school age on, approaches directed to the child stepped up self-care in defecation. This in turn allowed mothers to acknowledge their child’s growth, enabling them to entrust bowel management to the child, contributing to their own emotional stability.

Conclusion:  Autonomous defecation in children with anorectal malformation or Hirschsprung’s disease requires not only training for the child, but understanding and cooperation by the mother. And for this, preparatory interaction from an age before self-care is possible, and carrying through with the various stages of the program in tandem with the mother is believed essential for maximizing efficacy.