Intensive Bowel Management Program

Our Bowel Management Program is a one-week outpatient program for children who cannot control their bowel activity. The goal is to help children live clean and accident free. Our center will use a variety of methods to help children get the best quality of life possible. The program is primarily focused on enema therapy, but also makes use of nutrition, pelvic floor physical therapy, and behavioral therapy to make sure our children get the best outcome.

Each year, approximately 250 children from all over the world participate in this intensive program. Many of them are in regular underwear by the end of the week! Although the program is designed primarily for children 3 years and older, many adults have completed it with success.

The Bowel Management Program may be a good fit for patients with bowel function issues relating to the following conditions:

• Anorectal malformations / imperforate anus
• Cloacal malformations
• CHARGE syndrome
• Cloacal exstrophy
• Colonic motility disorders
• Encopresis
• Fecal incontinence
• Hirschsprung disease
• Idiopathic constipation (that has not responded to aggressive medical management)
• Neurogenic bowel
• Spinal dysraphism (Spina Bifida)
• Tethered spinal cord

Some children may not be able to have normal bowel control due to one or more of the issues listed above. This unfortunately leads to accidents, soiling and dependence on diapers. Without other options, many patients may resort to ostomy creation to control their bowel activity. Our bowel management program provides another option that can lead to a clean existence and the best quality of life possible.

Bowel Management Program Overview

We start patients in our Bowel Management Program through intensive outpatient therapy weeks, which take place twice a month. When people contact the center looking for our program, we review their information and craft a starting plan before the patients come to see us. Some children may require additional imaging and testing prior to starting the program. We do everything we can to ensure your visit is well coordinated and will fully meet your needs, because we know your time is very important.

The key to success in bowel management is clear expectations, dedication and teamwork among the patient, family and medical team. Bowel management is not a cure for any condition, but it is a unique treatment that has given thousands of children an excellent quality of life. We tailor each child’s regimen to their specific needs. Each child’s outcomes will depend in part on the severity of their condition, along with their ability to actively and fully follow the program.

What to Expect

Patients enter the program through a week-long intensive outpatient experience. We start with a remote (on-line) educational session on a Thursday afternoon. In this session, families get an overview of the program, and an opportunity to talk about expectations and ask any questions they may have. Some children may undergo a contrast enema on that day as well.

The week starts in person the next day and ends the following Friday, involving daily visits to Cincinnati Children’s.

On the first Friday of the program, you and your child will meet with one of our colorectal providers and a nurse from the Colorectal Center to establish a treatment plan for the week.

One of the ways bowel management may be different from things our patients have tried before is how we use imaging to help make therapy decisions. Each weekday, your child will come in for an abdominal X-ray to determine how effectively the colon was cleaned out by the enema. Our providers and nurses meet daily to review these imaging results and adjust the treatment plan as needed for your child.

Using our program’s digital smartphone app, MyChart, or a paper log, you and your child will report all bowel activity - output from the enema, bowel movements at other times, accidents, soiling, etc. to share daily with the care team.

Education is a big part of the Bowel Management Program. Each day throughout the week, a nurse will speak with you and your child to answer questions and provide information to make the regimen the best it can be.

We offer an optional parent and caregiver support group midweek, led by our licensed social worker. She will ask questions about family support and quality of life and can connect you with resources as needed.

During the Bowel Management week, your child may see providers from other specialties, such as nutrition, gastroenterology, pelvic floor physical therapy, and behavioral medicine and clinical psychology. Offering collaborative care with other specialists is all part of our commitment to ensuring the best outcome possible for your child.

Bowel Management Alternatives

While the Bowel Management Program may be the best option for many patients, it’s not right for everyone. At Cincinnati Children’s we tailor our care approach and consider each child’s condition, symptoms and what testing and management has been done in the past. Patients who are relatively early in the process and just need a bit more specialized care beyond what their primary care provider can offer should consider our Gastroenterology programs and services. For those patients who are already under Gastroenterology care, the next step would be to meet with our Neurogastroenterology and Motility Disorder specialists.

No matter which program your child is in, at every level your providers evaluate if that program is right for you and your child. And if the answer is anything but “Yes!” we will find the program that meets your needs.