Experiencing unpredictable and difficult problems with bowel function can affect your quality of life. It may prevent you from going out and socialising, getting on with your daily routine and undermine your self-confidence and self-esteem. So it is important to try to understand and manage the difficulties.
Bowel management is the process which a person with a bowel disability uses to manage faecal incontinence or constipation. People who have a medical condition which impairs control of their defecation use bowel management techniques to choose a predictable time and place to evacuate. A simple bowel management technique might include diet control and establishing a toilet routine. As a more involved practice, a person might use an enema to relieve themselves. Without bowel management, the person might either suffer from the feeling of not getting relief, or they might soil themselves.
Bowel control is often a challenge for children who are born with anomalies in their anus or rectum, Hirschsprung’s disease, and/or spina bifida. Medical providers can help anyone with long term bowel problems to develop a routine in such cases to assist children in managing their bowels so that they can otherwise live normally.
Bowel management is achieved mainly through a daily enema which empties the colon to prevent unwanted and uncontrolled bowel movements that day. Some patients also use laxatives and a controlled diet as part of their bowel management regimen. Another alternative is transanal irrigation.
Transanal irrigation of the rectum and colon is designed to assist the evacuation of faeces from the bowel by introducing water into the rectum via the anus. By regularly emptying the bowel using transanal irrigation, controlled bowel function is often re-established to a high degree in patients with bowel incontinence and/or constipation. This enables users to develop a consistent bowel routine by choosing the time and place of evacuation. An international consensus on when and how to use transanal irrigation for people with bowel problems was published in 2013. The article offers practitioners a clear, comprehensive and simple guide to practice for the emerging therapeutic area of transanal irrigation.
Determining the appropriate regimen to achieve successful bowel management is done under medical supervision. Care is tailored to suit each child and often requires a trial and error approach over the course of a week. The patient has an X-ray taken which is reviewed by their doctor. The doctor then recommends a course of action (e.g. enemas, laxative, and/or controlled diet). The next day, the process is repeated with modifications to help the child achieve a completely empty colon. After the course of this week, the doctor can determine the precise amount and combination of what the child needs to achieve bowel management. From then on the patient can continue the regimen on their own.
Bowel management does not cure faecal incontinence but can greatly increase the quality of life. With successful bowel management, a child may be more apt to establish independence in normal daily life. Children with severe incontinence may also be able to attend school and participate in activities they otherwise would never be able to.
Depending on the prognosis, some patients will continue using these techniques for life while others may gain some degree of bowel control and become “potty trained”. Children who practice bowel management often become unhappy as they age, especially at puberty, due to a feeling that the administration of enemas is an intrusion on their privacy, especially as it is difficult for them to administer the enema themselves.
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You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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