Dr JO Menakaya MA MRCP, Consultant Paediatrician Clinical Lead, The PURA Project, Hillingdon Hospital Middlesex, UK
Constipation if inadequately treated in paediatrics can result in long term difficulties often extending to adult life. The longer it takes for constipation to be treated, the worse the prognosis. In severe cases, faecal incontinence (encopresis) may be present.
Constipation and encopresis straddle the void between emotional wellbeing and physical health. A constipated child suffers a physical illness that impacts on his emotional health. His emotional wellbeing has a direct impact on whether this symptom gets better. We have pioneered an approach that addresses these issues simultaneously.
In our PURA service, children receive care from a multi-disciplinary team working simultaneously towards achieving a rapid return to optimum mental and physical wellbeing. In addition, some of these children following careful assessment are offered Trans Anal Irrigation. This service has enabled up to 75% of children with intractable constipation to improve within 1 year of referral. Our aim is to achieve this outcome within six months of referral. This attitude has improved the daily experiences of many children who have been referred to our service.
We are currently undertaking a quality improvement project to understand what best practice is for managing children with intractable constipation and encopresis. Working closely with children and their carers, this fresh approach will transform the care our affected patients receive.
