A neurogenic bowel results from a lack of nerve signals to the lower bowel. This can lead to two problems:
- The child does not know when he has to have a bowel movement.
- Accidents occur when there is a loss of muscle control.
Nerve loss makes your child unable to "hold" a bowel movement. The goal of bowel training is to help your child have bowel movements on a regular schedule. Hopefully, this will help avoid bowel "accidents." Bowel training is achieved when your child has a bowel movement in the potty at the same time every day and therefore has few bowel accidents.
Bowel training can begin anywhere from 15 months to 3 years of age (Picture 1). You will know your child is ready to start bowel training on the potty when he or she:
- Eats regular meals
- Can balance well in a seated position
- Is no longer drinking from a bottle
- Has regular bowel movements (1 or 2 a day)
Your child should also be aware that he has bowel movements. He should know where in his body they come from. Let him look at his bottom with a mirror. Let him touch this area and his genitals. Let him look at his stools and urine. This will help him become aware of this area of his body since he has no feeling there.
Eating the Right Foods
- Ask the doctor for a list of foods that are right for your child. The food your child eats affects how hard or soft his stool is and how regular his bowel movements are. The right foods provide enough bulk in the stool to help the bowel empty at one time. It will be easier to keep your child on a diet of these foods if the whole family eats the same things. Try to serve these foods to everyone.
- Your child should also be drinking enough liquids every day. A good amount for your child would be ______ ounces a day (_____ cups).
- It is also helpful to know which foods can cause loose stools. Keep a list of the foods that seem to cause your child to have loose stools.
Choosing the Right Potty Chair
Choose a potty chair or toilet seat adapter that meets all of the following needs:
- Your child can sit comfortably with both feet well supported (Picture 1).
- Your child's back is well supported.
- There are armrests for your child to lean on.
Gaining Your Child's Cooperation
- It is helpful to look at bowel training as a time of learning for your child. Like learning new words or learning to stack blocks, it takes time for a child to master what he has learned.
- The best way to gain your child's cooperation is to praise him when he is successful. Be kind and understanding when he is not. Do not punish your child if he has an accident.
- You are training your child's bowels to move at a certain time every day, not because of an "urge" to go. Your child will not have this urge like other children because of the loss of nerve signals to the area.
- Your child is active and busy. It may be hard for him to "stay put" in one place for very long. Do not expect him to sit on the potty-chair for longer than 5 to 10 minutes at a time.
- At this age, children like to copy what others do. It may help to let your child see other members of your family using the toilet.
- If possible, let your child wear loose-fitting clothes and training pants that he or she can easily remove and put back on. This will help your child learn independence. This will also help him realize that his stool should go in the potty and not in his clothes.
Learning the Words
Your child needs to learn words or cues before bowel training can begin. Choose the word you wish to use then start teaching your child to use it. For example, each time your child has a bowel movement (BM) in his diaper, you might say "Jason is having a BM." Repeat the same word each time you change his diaper. Soon your child will start to say a word that sounds like BM to himself and to you. After he is able to say the word and knows what it means, he will learn to expect to use the potty at this time.
Learning to Use the Potty
Decide on the time of day that best fits your schedule. To help your child train his bowel, plan on this time each day. Choose a time that is about 30 to 60 minutes after a hot meal. This stimulates a bowel movement. After breakfast and after dinner works for most children.
Help your child learn to bear down and grunt by making a game of it. Have him blow bubbles or puff his cheeks like a fish. Help him learn to massage his abdomen to create more pressure and stimulate the bowel (Picture 2). (Refer to Helping Hand HH-I-97, Neurogenic Bowel: Abdominal Massage.)
If the bowel does not begin to empty in 5 to 10 minutes, you can do one of these 3 things to begin the bowel movement:
- Do a brief rectal stimulation.
- Give a glycerine suppository.
- Give a normal saline "mini-enema."
(Refer to Helping Hand HH-I-99, Neurogenic Bowel Regulation, for instructions.) As your child gets older and gets used to this routine, he may wish to give his own suppository or enema.
Habits of Cleanliness
- Teach your child to wash his hands each time after using the potty.
- Empty the potty into the toilet after each use. Wash the potty with a household disinfecting cleaner, like Lysol. Rinse and dry it with paper towels. Store all cleaning supplies out of the reach of children.
- Children who are learning to use the toilet often put their hands on the toilet seat to brace themselves. It is important to wash the toilet seat and bowl with a disinfectant several times a week to keep germs from spreading.
Simple rewards may help your child to learn bowel training more quickly (Picture 3). When your child is successful, try one of these rewards:
- Read a special story.
- Allow play with one or two special toys which are only available after potty time.
- Play a special game together.
- Praise your child. Tell the family about his success.
Changes in Behavior During Bowel Training
Some young children try too hard to please their parents. They are afraid that they will have accidents. This may cause problems in other areas of their development. For example, your child may seem to be doing well with his bowel training, but will start refusing food or will not stay in his own bed. If these things happen, you can suspect that the training has become "too much" for your child. Try stopping the training for a week or so and see if the new problem goes away. If the problem remains, ease up on the training or give more praise when your child is successful. Make sure your child has the same daily bowel training routines at the babysitter or day care center.
Factors That Can Disrupt Bowel Training
Once your child has been bowel trained, several things can happen that may disrupt the regular bowel habits. These include:
- Being sick
- Being hospitalized
- Eating certain foods
- Taking certain medicines
- Family stress or a new baby in the home
Your child needs understanding and acceptance at these times, not punishment. Bowel training can take 3 months or more to complete, so patience and understanding will be needed during this time. Each child is different and masters bowel training at his own rate. If bowel training is not successful, your child may need the Bowel Management Program. (Refer to Helping Hand HH-II-222, Bowel Management Program, for more information).
If you have any questions, be sure to ask the doctor or nurse.
HH-I-180 12/93, Reviewed 3/14 Copyright 1993, Nationwide Children’s Hospital