What Is Bowel Management?

Your care team has recommended a bowel management week, but what exactly is bowel management and what can you expect during that week?

Bowel management is a 7-10 day medication manipulation program that helps patients establish better stooling patterns to help them get rid of stool accidents. Bowel management can be done with either oral medications or large volume rectal enemas. Patients who typically benefit from bowel management are patients with anorectal malformations (ARMs), Hirschsprung disease (HD), constipation, and patients with spinal anomalies (Myelomeningocele).

The week starts with a visit with either a Center for Colorectal and Pelvic Reconstruction (CCPR) surgeon or a CCPR advanced practice provider (nurse practitioner). At this visit the provider will take the time to get a full medical history and understand what has worked or not worked in the past. They will also discuss goals for the week for the patient as well as the family. The provider will use the information from the patient and family to decide on whether oral medications or large volume rectal enemas will give the patient the best chance of being continent. The providers rely on input from families to make this decision.

Every patient will have 2-3 visits throughout the week with their provider. These visits are used to assess how well the patients are doing on their new bowel regimens. The providers will give recommendations for any changes that need to be made to the medications at these visits, which may be completed either in person or via telehealth. Your team can help you decide on which of these options might be best for you.

Parents are an important part of the bowel management process, as the CCPR team relies on them to relay information on how patients are doing throughout the week. Parents are asked to keep a daily log of things like the number of stools their child has had in a day along with the number of stool accidents they have had and what medications they have taken that day. The parents then send that information to the team for review.

X-rays are completed throughout the week; families can expect anywhere from 3-7 x-rays to be taken during a bowel management week.

Patients can expect that their medications will need to be adjusted on most days, if not every day, of the bowel management week. The CCPR team uses the information that is reported by the patient and family on the daily log sheet, along with the x-ray images to make their decisions on changing the bowel medications. This information is shared with the family during their visits. On days when the patient does not have a visit, the team will be in contact to relay any medication changes that are recommended.

There may be times when the patient’s bowel regimen is improved, but still not perfect by the end of the bowel management week. Your CCPR team will continue to work with you and adjust medications outside of the dedicated bowel management week. This may require additional x-rays and visits with the CCPR team.

If you believe that your child might benefit from a bowel management week or to get more information on the Center for Colorectal and Pelvic Reconstruction (CCPR) at Nationwide Children’s Hospital, please call (614) 722-4086.