Welcome to

Bowel Management Week

A program of Reconstructive Pelvic Medicine

Notes

What is incontinence?

Incontinence is when a child is not able to control their bowel movements. This causes poop to leak from their rectum.

There are two types of incontinence: • Organic

• Functional

Notes

Organic incontinence

• Something a child is born with (congenital)ARM, Spine/sacrum defects

• Something a child developsTrauma, operative complications

Notes

Functional incontinence

Nerves and muscles are present, but not working properly.

Notes

Treatment for fecal incontinence

• Laxatives

• Enemas

• Antegrade continence enema (ACE)

Notes

Goal: social continence

Bowel management with enemas

Notes

Contrast enema

The contrast enema is an X-ray that gives a picture of your child’s colon.

• Diagnostic – it gives us information.

• Therapeutic – it helps empty the stool before Bowel Week starts.

Notes

Selecting the enema recipe

Based on your child’s needs, including the size of their colon.

Notes

First Friday of Bowel Week

• Clinic visit

• Contrast X-ray results

• Enema kit and recipe

• Plan for the weekend

Notes

Monday through Thursday

• Daily X-ray

• Daily phone report

• Team review• Call back with plan

Notes

Wednesday support group

Notes

Final Friday

• Meet your team in clinic

• Plan for ongoing follow-up

Notes

Demonstration

Notes

Creating successful enema routines

• Be consistent – same time and routine

• Keep it positive

• Include rewarding activities

• Give choices and control

• Emphasize the outcome

• Model communication

Notes

Enema troubleshooting tips

• Resistance

• Discomfort

• Leaking

• Headache – dehydration• Cramping – enema rate

Bowel management with laxatives

Notes

Finding the right laxative dose

Guess a dose to start on a Friday.

• If your child has diarrhea: Decrease the amount of laxative

• If no bowel movement: Give them an enema and increase the laxative

• If they have loose stool: You can give your child water-soluble fiber to give their stool bulk (pectin, Benefiber, Citrucel)

Notes

Types of laxatives

Laxative Pills/Tablets

Do not buy combination medicines like Senna plus Docusate

Notes

Types of laxatives

Laxative Squares

Notes

Types of laxatives

Laxative Liquid

Do not use products that do not have clear Senna dosing information.

Life with long-term enemas

Notes

Long-term enemas: non-surgical

Peristeen-type independent enema kits

Notes

Long-term enemas: surgical

Antegrade continence enema (ACE)

• Tube cecostomy

• Malone appendicostomy

• Neo-appendicostomy

Questions?