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Bowel Management Plan
What is the Bowel management plan?
The bowel management plan uses changes in diet, laxatives or enemas to assure that your child has daily bowel movements. It is an individualized plan to prevent your child from having bowel accidents.
Who needs bowel management?
Bowel management helps children who have problems having bowel movements (BMs) every day, or who have problems with stool soiling. Many times these are children who have had Hirschsprung's disease, imperforate anus, or problems with the bones in the lower spine.
How is the decision made that bowel management is needed?
Any child that is having problems with constipation or stool soiling will benefit from this plan.
What can I expect from the bowel management plan?
During the first visit, we will discuss your child's past medical and surgical history. This will include anything you have done to try to help your child with these problems (diet, medications, enemas, etc). It is important to gather all medical and surgical reports on your child. Request his/her operative reports, discharge summaries and x-ray reports from the Medical Records department of the hospital where your child was born or treated. Keep these in a safe place and bring them with you to this visit.
We may do an x-ray of your child's abdomen to see the condition of the intestines. We will discuss what each of us will do to help: your child, the parents, the surgeon and the advanced practice nurse. As time goes on, we will adjust the plan so that your child has daily BM's while staying clean during the day. The goal: no diapers in school!
What kind of care is needed at home?
We will talk about changes in diet that may affect the whole family (increased whole grains, higher fiber foods, and more fruits and vegetables). We will also tell you what foods to avoid. It will be important to have your child drink lots of water every day, but especially when it is hot and humid outside or at times of increased physical activity.
If medications are needed, we will give you a list of medications, doses and times of day to give them. If enemas are needed, we will give you specific instructions on how to give them.
What should I call the surgery team for?
Call the surgery office if your child does not have a BM each day. Also call for more BM's than normal, straining or smearing. If there is vomiting, especially yellow or green, or the belly looks swollen, or you have any other concerns, call the surgery office.
What are the long-term consequences?
Children with some bowel problems may need a bowel management plan for a long time. Parents often worry that the child will become "addicted" to laxatives or enemas. In this case, that is not an issue. Your child needs extra help to have daily BMs and remain clean. Talk about your concerns with the surgical team.
Will this affect growth and development?
Your child's normal growth and development should not be affected by bowel management. Maintaining good nutrition and fluid intake will be very important. Developmentally, your child may have concerns about the need to take medicines or laxatives. Talking honestly with your child and remaining calm during treatments is important. Talk to the surgical team so they can help with these concerns and guide you in working with your child.
Is there anything else I need to know to care for my child?
You are a very important part of the success of the bowel management plan. Continuing to work with the surgical team on an ongoing basis will help your child remain clean. By avoiding bowel accidents, your child will have an easier time in school, with friends and with family. Do not stop communication with the surgical team. Continuing follow up through the years will prevent problems. Your child needs your help now and in the future!
Please reproduce and distribute this sheet to your surgery families. This teaching sheet can also be downloaded at www.APSNA.org.
Copyright 2006, Fran Gill. Copied with permission by Jones and Bartlett Publishers, Sudbury, MA.