Children who cannot control their bowel movements often have many different problems. Most of the time, the problem is because of a digestive system malformation or disease, a spinal problem, or constipation.
Depending on the child’s problem, a bowel management program can:
- Help a child have control of bowel movements again.
- Keep a child out of diapers and free from accidents for 24 hours.
Who Needs A Bowel Management Program
Patients who are referred to the Nationwide Children’s Hospital Center for Colorectal and Pelvic Reconstruction (CCPR) Bowel Management Program have either a:
- Mechanical bowel problem – This happens when a child’s body parts that keep stool inside did not form the right way or did not form at all. It can happen with Hirschsprung disease or an anorectal malformation. This problem is called true fecal incontinence. Sometimes, the child has the parts he or she needs, but they do not work the right way to keep him or her from having soiling accidents.
- Medical bowel problem – This happens when children have all the working body parts to keep stool inside the body, but cannot make them work the right way. This usually happens because of severe constipation. This can happen in children with or without a history of rectal surgeries.
How It Works
Your bowel management program will be done over the course of a week at Nationwide Children’s Hospital. This is called ‘Bowel Management Bootcamp.’ Many other families will be doing the bootcamp too.
When you get to bootcamp, you will:
- Go to an orientation – day before first office visit
- Get an x-ray – every morning for the entire week, except weekends
- Talk with the CCPR bowel management team – every day of the week, except weekends
- Have an office visit with the CCPR team– first and last day of the week
- Get a plan from the nurse – every day
- Talk to any specialists, as needed
- Get your supplies for the week
After the first x-ray and exam, the doctor will choose which bowel management program your child needs during the office visit. This will be either:
- The Enema Program – usually for children who cannot control bowel movements because of body parts that do not work.
- The Medicine Program – usually for children who cannot control bowel movements because of body parts that do not know how to work.
The Enema Program
The Enema Program is usually ordered for children who have body parts that do not work right or never formed. This problem makes stool stay inside the body. The Enema Program uses a safe saline solution enema every day, to clean all of the stool out of your child’s colon. This keeps your child free from accidents. An enema is a process where a tube goes into your child’s rectum, and the saline is flushed into the colon. This loosens all of the stool in the colon, so that it all comes out at one time. The colon will stay clean until new stool is made the next day.
For the Enema Program:
- Your child will get an x-ray every day.
- Your child will get an enema every day.
- You will write down all details of the enema and bowel movements in the Daily Enema Program Chart every day.
- You will talk with the doctor or nurse about how your child did with the enema every day.
- You will get x-ray results and instructions for the next day’s enema every day.
The Medicine Program
The Medicine Program is usually ordered for children who have all the body parts needed to keep stool inside the body, but the body cannot work those parts the right way. This problem also makes stool stay inside the body. Many children on the Medicine Program only have problems with constipation. The Medicine Program uses medicine that makes the colon move so stool can come out of the body quickly. This medicine is called a laxative.
For the Medicine Program:
- Your child will get an x-ray every day.
- Your child will take laxatives every day.
- You will record all details of the laxative and bowel movements in the Daily Medicine Program Chart every day.
- You will talk with the doctor or nurse about how your child did with the laxatives every day.
- You will get x-ray results and instructions for the next day’s laxatives every day.
- You will have special diet instructions.
- Your child may have to have an enema.
After the Bowel Management Bootcamp
After Bowel Management Bootcamp, the doctor will give you and your child instructions for the bowel management program at home. It is important to remember that the program may change as your child gets older. He or she may become more interested in bowel management. Children on the Enema Program may be able to try the Medicine Program during breaks from school or sports. If your child has to have enemas every day, there are surgeries that can make this easier and more private.
Please contact the Center for Colorectal and Pelvic Reconstruction at 614-722-4086 or firstname.lastname@example.org if you have any questions or concerns.
HH-II-222 12/14 Copyright 2014, Nationwide Children’s Hospital