Bowel Management Program

It is best to give the enema around the same time every day, especially when your first start an enema routine. Consider what time of day will work best for your family. Allow 1 hour minimum for the enema process. You will give enemas every day or at least every other day. Most kids need daily enemas to stay clean and prevent constipation. If you give an enema every other day, expect your child to pass 2 days’ worth of poop (stool).It is best to give the enema around the same time every day, especially when your first start an enema routine. Consider what time of day will work best for your family. Allow 1 hour minimum for the enema process. You will give enemas every day or at least every other day. Most kids need daily enemas to stay clean and prevent constipation. If you give an enema every other day, expect your child to pass 2 days’ worth of poop (stool).

• Be positive, calm and matter-of-fact about enemas.
• Provide interesting activities and distraction to pass the time during the enema—make it fun.
• Padded toilet seats and tray tables can be helpful.
• Use a foot stool to rest their legs while on the toilet.
• Ask your child for feedback and allow them to make choices and have control when able. Encourage your child to help and be part of the process.

• Allow 1 hour from start to finish. Speed is not the goal with enemas— slower gives best results.
• Drip the fluid slowly over 10 minutes, then let the fluid stay inside the colon (dwell) another 10 minutes.
• Then have your child sit on the toilet for as long as needed (usually 40 minutes) to completely empty the colon.
• Half-way through the sit time, have your child stand up (if able), move their body and massage the belly, to help any retained fluid come out in the toilet.

Emptying the colon each day allows the colon to retain its natural size and function. Enemas are not necessarily forever—some kids will have increasing ability to control when they poop as they get older.

Sometimes after a period of successful bowel management, a child begins to soil their underwear or diaper again. This is a sign that something has changed. We may need to adjust the routine.

A belly (abdominal) X-ray helps us see if poop is building up in the colon. We may need to adjust the enema solution or how often you give them.

If the X-ray shows an empty colon, soiling may be due to a fast-moving colon. Medicine and a careful diet can help slow the colon, too.

Any changes in your child’s routine can affect the success of bowel management. Changes in diet, illnesses, or not drinking enough water (dehydration) can disrupt the program. Life changes like divorce, moving, or changing schools all play a role in bowel function. Contact the bowel management team to adjust enemas as necessary.

Some kids with altered nerves and muscles of the pelvis need bowel management for life. But some develop increasing bowel control with time. As they get older, children become more socially aware and can detect subtle body signals.

It is possible that later in life, your child can stop using enemas. They may stay clean using laxatives and by following a careful diet with regular meals (3 meals per day and no snacks), so they poop at a predictable time.

The success of these strategies depends upon anatomy, awareness, and a partnership between family, your child, and the healthcare team. It takes dedication, determination, consistency, and love from everyone involved.

If your child meets all 3 of these conditions, they might be able to stop the daily enemas:

1. Is completely clean with bowel management. This means no soiling and regular bowel movements after every enema for some time.
2. Is motivated. Your child must be aware of their situation and want to try new strategies to stay clean.
3. Understands there is a chance it won’t work. If you decide to try and control your child’s bowel movements through diet, medicine or both, you must be willing to return to the bowel management program. This means a daily enema if your child’s pooping is not predictable, and they have accidents again.