Fecal Incontinence and Bowel Management in Children
May 11, 2018
Fecal incontinence is a tough subject to discuss, however, there are many children around the world who struggle with this on a daily basis. It is commonly seen in children with anorectal malformations, Hirschsprung disease, spinal or sacral anomalies, or those with severe constipation. No matter the diagnosis, there are several methods of bowel management which can help keep a child be clean and in normal underwear.
The type of bowel management program your child needs is based on their underlying diagnosis, previous surgical history, age, imaging, and symptoms. Some children have fecal incontinence episodes due to an overflow of stool within the colon. Other children have fecal incontinence because their sensation mechanism was damaged during surgery, or they have poorly formed anal sphincters. No matter which category your child fits into, there is a type of bowel management out there for them.
One type of bowel management program is done with administration of oral medications. The type of oral medication is based on whether the child has a hypomotile (slow moving) colon or a hypermotile (fast moving) colon. For those with hypomotility, a stimulant laxative such as senna or bisacodyl can be utilized to increase peristalsis of the colon. Water soluble fiber is typically paired with this medication to give the stool the proper consistency. Children with hypermotility need a combination of oral medications to slow down their rate of stooling. These may include anti-diarrheal medications such as pectin, loperimide, cholestyramine, levsin and lomotil.
Another bowel management method is the administration of a large volume rectal flush. This involves placing a catheter in the rectum, creating a seal around the sphincter muscle, and administering fluid mixed with stimulants. The fluid flows into the colon over a 10 minute time period. After that time, the fluid remains in the colon for another 10 minutes. Once this is complete, catheter is removed and the fluid mixture with stool is released. This is a way of mechanically cleaning the colon, forcing it to move stool out when it is not able to do so on its own. The goal of this method is to flush the colon once each day and have no passage of stool between each flush.
A rectal flush can be uncomfortable and cause anxiety for children and their parents. There are many things which can be done during the flush to make it more comfortable. They include: warming the flush solution, slowing down the infusion rate, and changing the type of stimulant used. If a child is successful on rectal enemas, the medical team may recommend a surgery called a Malone where the flush is able to be given through the belly button instead of the bottom.
Management of fecal incontinence is individualized and there is no exact formula for a child’s specific regimen. Several modifications may need to be made over the course of a child’s program including adding, changing, or adjusting dosages of medications. It’s important for parents to remember patience, as it will take time for their child to adjust to this new program and for their team to find the right combination of medications. Some hospitals have a dedicated bowel management program week to help children find what will work for them. To learn more about Nationwide Children’s Hospital’s bowel management program through the Center for Colorectal and Pelvic Reconstruction, click here, call 614-722-4086 to talk with our team.
Meghan Fisher, BSN, RN, is the Clinical Leader of Education at the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s Hospital. She received her nursing degree from Capital University.
Erin Shann, BSN, RN
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