Bowel Management - Overview

Overview

Bowel management is mainly achieved through a daily enema which empties the colon to prevent unwanted and uncontrolled bowel movements that day. Some people also use laxatives and a controlled diet as part of their bowel management regimen. Determining the appropriate regimen to achieve successful bowel management is done under medical supervision. Care is tailored to suit each child and often requires a trial and error approach over the course of a week. The patient has an X-ray taken which is reviewed by their doctor. The doctor then recommends a course of action (e.g. enemas, laxative, and/or controlled diet). The next day, the process is repeated with modifications to help the child achieve a completely empty colon. After the course of this week the doctor can determine the precise amount and combination of what the child needs to achieve bowel management. From then on the patient can continue the regimen on their own.

Bowel management does not cure fecal incontinence, but can greatly increase quality of life. With successful bowel management, a child may be more apt to establish independence in normal daily life. Children with severe incontinence may also be able to attend school and participate in activities they otherwise would never be able to.

Depending on the prognosis, some patients will continue using these techniques for life while others may gain some degree of bowel control and become "potty trained". Children who practice bowel management often become unhappy as they age, especially at puberty, due to feeling that the administration of enemas is an intrusion on their privacy, especially as it is difficult for them to administer the enema themselves. An operation called a continent appendicostomy or Malone procedure is available. This allows a person to give themselves an enema by inserting a catheter into a small orifice at the belly button.