700 Children's® – A Blog by Pediatric Experts

Long-Term Bowel Management: Letting Kids Be Kids!

Feb 18, 2020
One kid pushing another kid on a swing set

All children are special, and every single child has something unique about them which is a wonderful thing! Sometimes, however, kids just want to be kids and enjoy the developmental activities that come along with growing up without unwanted interruptions. It is important to help these children so they can enjoy pastimes just like their friends, including sports, sleepovers, camping trips and other common childhood activities.

What Is Bowel Management?

Bowel management is an ongoing strategy that includes methods to manipulate stooling patterns in order to empty the colon of stool and keep children from having accidents. Bowel management includes one of two different programs – rectal/antegrade enemas and oral medications. Oral medications are those taken by mouth or feeding tube. Enemas can be given in two different ways: via rectum (from the bottom) or via antegrade (“in the direction of normal flow” – from the top down).

Who Needs Long Term Bowel Management?

Long term bowel management may be needed for almost anyone and can be a lifelong process requiring ongoing management. This is due to healthy development and changes that occur throughout the lifespan. Most common individuals needing a long term bowel management program are those with anorectal malformations, Hirschsprung disease, severe functional constipation and spinal abnormalities. Each child may be affected in different ways, but all seek help to have better emptying with daily bowel movements while preventing unwanted leakage, constipation, pain and discomfort.

What Are Rectal Enemas Versus Antegrade Flushes?

Rectal enemas are delivered through the anus and empty the lower part of the colon.

Antegrade flushes are an alternative route to flushing out the colon. Instead of flushing from the bottom up, as with a rectal enema, the antegrade flush enters the colon from the top down and flows out in the natural direction of stool flow. An opening is made using the appendix or a piece of the small bowel usually at or around the belly button. This opening allows a catheter to deliver a special flush mixture to go through the colon and then exit the body through the anus into the toilet. Both options can evacuate stool and keep the child free of stooling accidents for 24 hours. There may be periods of adjustments to the medication regimen by the doctor or nurse practitioner.

What Is an Oral Medication Regimen?

Oral medication regimens are used to help with consistent bowel movements. When a well-established oral medication plan is put in place by a health care provider, the medication helps the bowel to give cues to help remove any unwanted stool. Over-the-counter medications can help stimulate the colon on when to start moving stool along and out of the body. In some cases, children will also take a water-soluble fiber to “bulk up the stool”. The goal of an oral medication regimen is 1-2 soft and well-formed bowel movements every day.

All rectal enemas, antegrade flushes, and oral medication regimens should be started and managed by a medical team trained in the monitoring and prescribing of these therapies. 

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Featured Expert

Marissa Condon
Marissa Condon, BSN, RN
Center for Colorectal and Pelvic Reconstruction (CCPR)

Marissa Condon, BSN, RN, serves as a clinical leader at the Center for Colorectal and Pelvic Reconstruction (CCPR) at Nationwide Children's Hospital. She received her BSN from Lourdes University in Sylvania, Ohio. She has traveled internationally speaking on colorectal diagnoses.

Patrick Queen
Patrick Queen, BSN, RN
Center for Colorectal and Pelvic Reconstruction (CCPR)

Patrick Queen joined the Center for Colorectal and Pelvic Reconstruction (CCPR) as a nurse clinician at Nationwide Children’s Hospital in 2018. Patrick obtained his BSN at Mount Carmel College of Nursing in Columbus, Ohio.

Casey Trimble
Center for Colorectal and Pelvic Reconstruction (CCPR)

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Pediatric News You Can Use From America’s Largest Pediatric Hospital and Research Center

700 Children’s® features the most current pediatric health care information and research from our pediatric experts – physicians and specialists who have seen it all. Many of them are parents and bring a special understanding to what our patients and families experience. If you have a child – or care for a child – 700 Children’s was created especially for you.