Bowel Management

Many children have difficulty controlling their bowels or anticipating a bowel movement.  This can be due to a number of conditions including constipation, behavioral disorders, neurogenic bowel disorder or other pelvic disorders.  As well, stooling disorders may follow surgical procedures for Hirschsprung disease, imperforate anus.

The C.S. Mott Children’s Hospital Colorectal Program offers advanced diagnosis of the cause for your child’s bowel control problems, effective treatment options for the underlying condition, and individualized techniques to help your child attain better bowel control. 

Bowel management problems, sometimes referred to as fecal incontinence, can lead to a number of challenges for children, including their ability to develop active lifestyles, maintain friendships, and achieve independence as they grow into adolescents and teens.

Our goal is to help your child avoid the need for a permanent colostomy or dependence on diapers.

Bowel management techniques

Children are evaluated by our multidisciplinary colorectal team, which can include specialists from pediatric surgery, pediatric urology, pediatric gastroenterology, pediatric radiology, nurse specialists, nutritionists, behavioral pediatrician, psychologist and physical therapy.  Part of your child’s evaluation will be designed to determine colonic motility, anal sphincter function as well as defectation (or the passage of stool through his/her anal canal). 

Generally, patients with bowel management problems fall into two categories – children whose problems relate to constipation and children whose problems relate to diarrhea.

For children with bowel management problems stemming from diarrhea, treatment will focus on creating a diet that slows the motility of the colon while keeping it clean.

Children with problems stemming from constipation generally benefit from treatment involving the use of enemas to thoroughly clean the colon.

Each child’s plan is highly personalized.  Most children will attend our clinic multiple times over the course of a week so we can fine tune the treatment plan.  Often, this includes period abdominal x-ray exams to determine how well the colon is functioning and achieving cleanliness between enemas.

Surgical bowel management techniques

Some children may require long term care as part of their bowel management journey.  This can include long term use of enemas, or surgical treatment for a small segment of bowel management patients.

An appendicostomy or cecostomy, also referred to as the Malone procedure, MACE or ACE procedure, connects the appendix or cecum to abdominal wall using a small catheter.  This procedure allows for daily flushing of the colon. This surgical approach is performed for many children who suffer from anorectal incontinence.  We have found great success in performing this procedure, and we have often performed this procedure before a child begins school.  In many of our patients we have found a significant improvement in family satisfaction and quality of life!

For the small number of children who do not have successful results from bowel management techniques, we are able to offer colostomy as a treatment option.

We also work closely with the University of Michigan Bowel Control Program for seamless transition of care as patients become adults.

Comprehensive support for patients

As a part of the coordinated care your family will receive from our team, you will have access to behavioral pediatrics, pediatric psychologists and a nurse practitioner with deep experience working with children with elimination disorders or encopresis.  We will work with your family to address the emotional and psychosocial challenges that often come along with struggling with bowel management problems, such as shame or embarrassment your child may feel as a result of soiling problems.  Together with your family, we can help your child establish a more healthy and positive outlook on their bowel management journey.

Discover the Michigan Difference in pediatric colorectal surgical care.

For more information or to make an appointment, call 1-877-475-MOTT (1-877-475-6688).