What is a bowel management program?
A bowel management program is a treatment for children who have problems controlling their bowel movements. It is designed to help a child keep "socially clean" using an enema so that they can wear underwear and not soil their clothes.
A child can have problems controlling their bowel for different reasons. Some children are born with conditions such as anorectal malformation or spina bifida that make bowel control difficult. Others might develop problems with bowel control later in life, for example if they are experiencing trauma.
Goal of a bowel management program
The goal of a bowel management program is to keep the bowel empty for 24 to 48 hours. If the bowel is empty, a child should not have fecal soiling between enemas.
The length of the bowel management program depends on each child's needs. For many children, this will be a program that they need to follow for the rest of their lives so that they can stay "socially clean".
Benefits of a bowel management program
A bowel management program can help your child feel more confident and allow them to take part in the same activities as other children their age, including swimming, schooling and family outings. Families can benefit too: improved continence reduces family stress about fecal soiling outside the home.
How a bowel management program works
The bowel is cleaned with an enema every day or every other day. The enema contains a saline solution (mix of salt and water) that is poured into the bowel to flush out stool.
There are two main types of enema:
- retrograde enema
- antegrade continence enema
Retrograde enema
A retrograde enema is given by passing a soft tube through your child's anus so that the liquid can be flushed into your child's bowel.
| Benefits of retrograde enemas | Problems with retrograde enemas |
|---|---|
| Your child will have more control over fecal soiling. |
The enema is more invasive than an antegrade continence enema (see below). |
| Your child will not need any anaesthetic, surgery or X-rays before enemas can start. | Your child will normally need someone to perform a retrograde enema for them. This results in a loss of privacy that is likely to be more difficult for your child as they get older. |
| Your child may still leak stool. |
Antegrade continence enema
An antegrade continence enema (ACE) is given through a specially-created passage between your child's abdomen and intestine. This passage can be made by either:
- an appendicostomy
- a cecostomy
Each option involves creating a stoma (opening) on your child's abdomen to allow a tube to be inserted for the enema.
| Benefits of ACE through an appendicostomy | Problems with ACE through an appendicostomy |
|---|---|
| Your child will have more control over fecal soiling. | The stoma may narrow or possibly become blocked (known as stoma stenosis). |
| Your child will have more control and independence in managing their bowel movements from an early age. | The passage may become infected. |
| The stoma may produce mucus. | |
| Your child might still leak stool. | |
| The surgery to create the passage for the enema might cause a kink in your child's bowel. This could cause feces to become blocked. | |
| As your child grows, they may need a larger tube for the enema. This tube may be too big for the passage, so your child might need more surgery to make the passage larger. |
| Benefits of ACE through a cecostomy | Problems with ACE through a cecostomy |
|---|---|
| Your child will have more control over fecal soiling. | Your child might still leak stool. |
| Your child will have more control and independence in managing their bowel movements from an early age. | Your child may develop granulation tissue (red, bumpy skin that can bleed and ooze) around the tube site and need treatment to ease it. |
| The stoma may produce mucus. | |
| The tube may be pulled out. | |
| The tube must be changed every year. |
How to choose the right bowel management option
Your child's surgeon will explain each bowel management option to you. Together, you and the surgeon will decide which treatment is best for your child based on their current medical condition and long-term needs.
Virtual care services for children
Boomerang Health was opened by SickKids to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support bladder and bowel dysfunction, visit Boomerang Health powered by SickKids.
Sources
American Pediatric Surgical Nurses Association. Bowel Management Program Teaching Sheet.
Cincinnati Children's Hospital Medical Center. Bowel Management Program.