Bowel Management Week

It is a week-long outpatient clinic-based program at Seattle Children’s Hospital. We offer it several times during the year. The goal of the program is for your child to be “socially continent.” This means they can wear underwear without poop accidents. Some children can stay clean in underwear by the end of bowel week. Others may take a bit longer to achieve this goal.

Some children can be successful controlling bowel movements through a medicine (laxative) program. Others, because of the type of issues they have, are not able to have voluntary bowel control but can become clean through an enema program.

The choice about when and how to start bowel management is up to you. For most families, we recommend starting a bowel management program around 3 to 4 years old. At this age, most children are no longer wearing diapers.

Your child must be at least 3 to start bowel week, but many children begin later. Your child must be able to sit on the toilet, pull their pants on and off by themselves, and wipe themselves.

Children with bowel incontinence or soiling are not self-conscious when they are young and in diapers. Your child might notice their problems when they see other children begin to wear underwear while they are still in diapers.

We never force your child to participate. It is always a cooperative effort between you and your child. Talk to your bowel management nurses if you have worries about your child’s readiness to cooperate. We use many skills to keep this a positive experience for everyone.

Toilet training for pooping is a long-term goal for children with anorectal malformations. If your child was born with a type of defect that has a good outcome (prognosis), your child may be able to toilet train. Here are a few tips for toilet training your child:

• Keep it simple: Between the ages of 2 and 3, sit your child on the toilet after every meal. Allow your child to play with toys while on the toilet.
• Keep it light: Treat toilet training as a game and not as a punishment. Sit with your child and do not argue or force them to stay seated. If your child gets up, put the toys away.
• Keep it fun: Reward your child for pooping or peeing while on the toilet.

If your child is not toilet trained by school age, there are several options: 

1. Delay sending your child to school for another year to keep working on toilet training.
2. Sign up for and start a scheduled bowel management week the year before school starts . During that time, we will teach you to use enemas or medicines to help keep your child clean.
3. Work with the school to develop a plan for toileting supports at school. 

The goal is for your child to wear regular underwear to school without being teased by classmates who are already toilet trained.

• Find housing. Arrange childcare.
  This program starts on a Friday and continues until the following Friday. During this week, your family may need to stay near the hospital, so you can fully focus on the program. Arrange to take off work and find alternate childcare during the week. You will need transportation to get to and from radiology for daily X-rays. It’s best if your child stays home from school and limits social activities during the week. Sometimes your child will need other clinic visits here before they can start the week. This is a significant commitment for families and is a concentrated week-long effort focused on social continence. If you have questions about how this can work for your family, talk with the bowel week nurses.
  
  If you are travelling a long distance, and need help with housing or transportation, contact our Guest Services department at 206-987-9330 or 866-987-9330 (toll-free).
  They are available:
  • Monday through Friday (8 a.m. to 6:30 p.m.)
  • Saturday (12 p.m. to 6 p.m.)
  • Anytime by email at [email protected]
• Contrast enema
  Your child will need a contrast enema in the rectum before bowel week begins if they have not had one recently. Your child will do this in the radiology department, usually 1 to 2 days before bowel week starts. For more information, please see our handout “Contrast Enema.” seattlechildrens.org/pdf/PE714.pdf
• Collect supplies
  If your child is on an enema program or we think they may need enemas, a supply company may call you to arrange for a delivery of enema supplies to your house. Please let us know if you already have a supply company.

   

Day 1

On the first Friday morning of bowel week, we will X-ray your child’s belly (abdomen). You and your child (if developmentally appropriate) will attend an online video class that morning, along with other families in the program. In the afternoon, you will have an in-person clinic visit with the doctor to discuss the plan for the rest of the week. We will give you a notebook that describes your child’s program in detail. You will also keep track of your child’s daily pooping habits in this notebook, which you will share with your child’s nurse during the week. If starting on an enema program, you will also receive an enema starter kit including needed supplies.

Days 2-3

Saturday and Sunday are “free days,” your child does not need to come in for an X-ray. The weekend will allow you some time to practice and adjust to the new enema or laxative program. Use the daily logs in your notebook to write down details of your child’s enema or laxative program. You will use these notes when you talk with your child’s nurse during the week.

Day 4-6

Beginning the next Monday, you will come to Seattle Children’s in the morning for an X-ray. In some cases, your child may be able to have X-rays at a location near your home. The team will let you know before bowel week if this is possible. You will also give a phone report each day to the nurse describing the effects of the enema or laxative from the night before.

The team will meet in the early afternoon daily to review the X-rays. If you need to make changes to the enema or laxative, we will call you and let you know what changes to make. Please write these changes in your notebook.

Midway through the week, we will offer an hour-long online video parent support group. This is a chance to connect with other families facing similar challenges in giving enemas for the first time.

Day 7

On Friday morning, you will have a wrap-up visit (either in person, or via telehealth video visit) with our team to discuss the ongoing plan. Some children need enemas or laxatives for months, years, or sometimes the rest of their lives.

After the program, we will continue to work with you on your child’s treatment plan.

Everyone will have a follow-up visit, either telehealth or in-person, within a month of bowel week. We will discuss other follow-up visits on a case-bycase basis.