Table 2, continued
Age group	Guidelines		Evidence
6–12 years, 11 months	1.	Discuss consequences of constipation and bowel incontinence (including shunt malfunction, urinary incontinence, UTIs, skin breakdown, social isolation) and focus on developing independent management skills.	[3–5, 7, 10, 18, 23], Self-Management and Independence Guidelines
	2.	Establish the goal of bowel continence and institute the bowel continence program using guidelines below.	[3–5, 7, 10, 18]
	3.	Assist the child with learning how to minimize and manage bowel accidents.	[7, 11, 24, 26]
	4.	Use barrier creams to protect perineal area from breakdown as needed.	[11, 17, 24] Integument (Skin) Guidelines
	5.	Keep a bowel habit diary to better understand triggers for incontinence and overall patterning to direct a choice of options for bowel management.	[10–12, 17, 18]
	6.	Focus on fiber, fluids, exercise, and timed bowel movements after meals.	[8, 11, 14–15, 18–19]
	7.	Consider twofold attack of oral and rectal interventions to meet the goal of bowel continence without constipation or fecal incontinence.	[8, 11, 14–15, 18–19]
	8.	Use dietary management (fiber, fiber supplements, and fluids), pharmacologic adjuncts (sennoside, polyethylene glycol), and/or rectal stimulants (glycerin, docusate sodium, or bisacodyl suppositories) to manage constipation.	[8, 11, 14–15, 18–19]
	9.	Discuss other options for treatment if the above have failed, including cone enema or other transanal irrigation, cecostomy, or MACE.	[8, 11, 14–15, 18–19, 25–28]
	10.	Refer to a Spina Bifida clinic or specialist with expertise in bowel management in Spina Bifida.	[8, 10, 11, 19], clinical consensus
13–17 years, 11 months	1.	Discuss consequences of constipation and bowel incontinence (including shunt malfunction, urinary incontinence, UTIs, skin breakdown, social isolation) and focus on developing independent management skills.	[3–5, 7, 10, 18, 23], Self-Management and Independence Guidelines
	2.	Establish the goal of bowel continence and institute the bowel continence program using guidelines below.	[3–5, 7, 10, 18]
	3.	Assist the child with learning how to minimize and manage bowel accidents.	[7, 11, 24, 26]
	4.	Use barrier creams to protect perineal area from breakdown as needed.	[11, 17, 24] Integument (Skin) Guidelines
	5.	Keep a bowel habit diary to better understand triggers for incontinence and overall patterning to direct a choice of options for bowel management.	[10–12, 17, 18]
	6.	Focus on fiber, fluids, exercise, and timed bowel movements after meals.	[8, 11, 14–15, 18–19]
	7.	Consider twofold attack of oral and rectal interventions to meet the goal of bowel continence without constipation or fecal incontinence.	[8, 11, 14–15, 18–19]
	8.	Use dietary management (fiber, fiber supplements, and fluids), pharmacologic adjuncts (sennoside, polyethylene glycol), and/or rectal stimulants (glycerin, docusate sodium, or bisacodyl suppositories) to manage constipation.	[8, 11, 14–15, 18–19]
	9.	Discuss other options for treatment if the above have failed, including cone enema or other transanal irrigation, cecostomy, or MACE.	[8, 11, 14–15, 18–19, 25–28]
	10.	Refer to a Spina Bifida clinic or specialist with expertise in bowel management in Spina Bifida.	[8, 10, 11, 19], clinical consensus
	11.	Access support services for personal care, if needed.	[11–12, 19, 24]
18$+$ years	1.	Discuss consequences of constipation and bowel incontinence (including shunt malfunction, urinary incontinence, UTIs, skin breakdown, social isolation) and focus on developing independent management skills.	[3–5, 7, 10, 18, 23], Self-Management and Independence Guidelines
	2.	Establish the goal of bowel continence and institute the bowel continence program using guidelines below.	[3–5, 7, 10, 18]
	3.	Assist the child with learning how to minimize and manage bowel accidents.	[7, 11, 24, 26]
	4.	Use barrier creams to protect perineal area from breakdown as needed.	[11, 17, 24] Integument (Skin) Guidelines
	5.	Keep a bowel habit diary to better understand triggers for incontinence and overall patterning to direct a choice of options for bowel management.	[10–12, 17, 18]
	6.	Focus on fiber, fluids, exercise, and timed bowel movements after meals.	[8, 11, 14–15, 18–19]
	7.	Consider twofold attack of oral and rectal interventions to meet the goal of bowel continence without constipation or fecal incontinence.	[8, 11, 14–15, 18–19]
	8.	Use dietary management (fiber, fiber supplements, and fluids), pharmacologic adjuncts (sennoside, polyethylene glycol), and/or rectal stimulants (glycerin, docusate sodium, or bisacodyl suppositories) to manage constipation.	[8, 11, 14–15, 18–19]
	9.	Discuss other options for treatment if the above have failed, including cone enema or other transanal irrigation, cecostomy, or MACE.	[8, 11, 14–15, 18–19, 25–28]
	10.	Refer to a Spina Bifida clinic or specialist with expertise in bowel management in Spina Bifida.	[8, 10, 11, 19], clinical consensus
	11.	Access support services for personal care, if needed.	[11–12, 19, 24]