Table 1.

Clinical questions that informed the bowel function and care guidelines

Age group (from guidelines)	Clinical questions
0–11 months	• What evidence exists that prevention of constipation in the first year of life improves outcome of bowel management in later childhood?
1–2 years 11 months	• Is there evidence to support the benefit of toilet training a child with Spina Bifida at the same developmental stage as peers without dysfunction?
3–5 years 11 months	• Is there evidence that “habit training,” or forced evacuation with stimulants, such as suppositories or enemas, increases social continence?
6–12 years 11 months	• What is the evidence that the MACE (Malone antegrade continence enema) procedure or continent cecostomy is an effective form of bowel management in children with refractory incontinence? • What are the most effective protocols for MACE (ACE) management? • What is the evidence that electrical stimulation (sacral nerve or intravesicular) provides benefit for increased bowel continence?
13–17 years 11 months	• What support is needed by young adults with Spina Bifida to be successful in maintaining their bowel program? • Is there evidence that hormonal fluctuations impact continence?
18$+$ years	• What impact does pregnancy have on bowel management or on use of a cecostomy or MACE? (Women’s Health Guidelines) • Does early chronic constipation impact management of constipation in adult years? • Is there a change in bowel function later in life that should be addressed with a more aggressive bowel program? Does menopause result in changes?