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Bowel Management Program for Neurogenic Bowel

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Bowel Management Program for Neurogenic Bowel Bowel Management Program For Neurogenic Bowel Normal Bowel Function: The bowel is the last portion of the digestive tract, sometimes called the large intestine. The digestive tract is a hollow tube that starts at the mouth and ends at the rectum and anus. The function of the digestive system is to take food into the system and get rid of waste. Food moves through the intestine by a reflex called peristalsis. Peristalsis moves the food forward. Nutrients are absorbed from the food as it moves through the intestine. The waste products of eating are stored until they are emptied from the body in the form of stool. A bowel movement happens when the rectum is full of stool and the muscle around the anus opens. Bowel Function and the Neurogenic Bowel: When normal bowel function is lost due to spinal nerve damage it is called a neurogenic bowel. This means a loss of sensation that the bowel is full, loss of the “urge” to empty the bowel and loss of control of the muscle around the anus (called the sphincter). This can also affect normal peristalsis and cause slow movement of food through the intestines. There are two types of neurogenic bowel depending on the level of nerve damage in the spinal cord. Reflex Bowel: Flaccid Bowel: • The anal sphincter remains closed. • There is reduced peristalsis and a loss of • A reflex bowel movement can happen any anal sphincter tightness. time and without warning when the • The bowel does not usually empty by itself. rectum fills with stool. • The loose sphincter muscle can cause leaking of liquid out the anus. Causes of Neurogenic Bowel: Many conditions can cause nerve damage to the lower spine that will affect bowel function. Some of the conditions that cause neurogenic bowel are: spina bifida, tethered spinal cord and spinal cord injury. The neurogenic bowel does not have normal bowel function. Your child may have problems with stool control and constipation. Both types of neurogenic bowel can be managed with success and prevent unplanned bowel movements and constipation. Approved by the MemorialCare Miller Children’s & Women’s 1 Hospital Long Beach Patient & Family Education Committee What is a Bowel Program? The bowel program gives your child the ability to maintain control of bowel movements. A bowel program is designed for the type of neurogenic bowel your child has. A bowel program may consist of one or more of the following: manual removal, digital stimulation, suppository, mini-enema, nutrition, activity and exercise. Goals of the Bowel Program: • Retrain the bowel to empty at planned and regularly scheduled times. • Avoid accidental, unplanned bowel movement. • Avoid leakage between each bowel program. • Maximize stool removal with each bowel program. • Maintain normal stool consistency. • Complete within 60 minutes. • Feel secure to participate in daily activities. • Keep the digestive system healthy. Getting Started with Your Child’s Bowel Program: There are two phases to a bowel management program: 1. Clean Out Phase 2. Maintenance Phase Clean Out Phase: During the clean out phase, the goal is to clear the entire bowel of stool. Depending on the amount of stool, this phase may take 1 - 2 days in the hospital or 3 - 7 days at home. Your health care provider will determine whether you will be admitted to the hospital for intravenous (IV) hydration and medication such as GoLYTELY or stay at home and use Miralax (polyethylene glycol) and mini enemas such as Enemeez. Maintenance Phase: Once the bowel has been cleaned out, you shift into the maintenance phase. This phase is life-long and will be part of your daily routine. The goal of this phase is to maintain regular bowel movements to keep the bowel empty. The simplest plan that works for you or your child is the best. Bowel management programs may include the following a “daily sit,” dietary changes to increase fiber and fluid intake, daily exercise, digital stimulation and medications. 2 Daily Sit: When your child is of normal potty training age, incorporate the “daily sit” into his/her routine. It works best after a meal because peristalsis helps stimulate the bowel to move. Ask your child to sit on the toilet about 30 minutes after a meal: breakfast, lunch or dinner. Usually, the “daily sit” is done within five minutes or so after the administration of a suppository and/or mini-enema. The most important thing to remember is to do the daily sit at the same time each day in order to retrain the bowel. Consistency is the key to success. Digital Stimulation: This procedure will make the anal opening relax. Insert a gloved lubricated finger (15-60 seconds) into the anus and make a circular motion until the anal muscle relaxes. You may need to repeat the digital stimulation every 5 - 10 minutes until the stool is passed. You will be discharged with a bowel program for your child’s needs. Fluid Intake: Both food and beverages contain fluid. Your child needs at least this much fluid from beverages: Age (years) Male Female 1 - 3 4 cups 4 cups 4 - 8 5 cups 5 cups 9 - 13 8 cups 7 cups 14 - 18 11 cups 8 cups 19+ 13 cups 9 cups Adapted from: 2004 National Academy of Science Recommendations Providing Juice for Constipation: Start by giving 1 - 2 ounces of 100 percent prune, pear or apple juice twice a day. These juices naturally contain sorbitol, a sugar alcohol that helps loosen your child’s stool making it easier to be pushed out of the body. If your child continues to have constipation, please contact your health care provider. Age Recommended Juice Intake 1- 6 years old Up to 6 ounces per day 7 years & older Up to 12 ounces per day Reference: AAP 3 Nutrition: Eating a healthy diet that contains plenty of fruits, vegetables and fluid is one way to treat constipation. Your child’s fiber needs should be individualized based on stool consistency and frequency. The portion of plant foods that the body cannot digest is called fiber. The undigested fiber absorbs water in the intestines, which enlarges the stool, making it softer and easier to push out of the body. If fiber is added or increased too quickly it can cause cramping, diarrhea and discomfort. • Increase fiber intake gradually. • Include fiber in every meal and from a variety of sources. • These foods add fiber to your diet: fresh, frozen, canned fruits and vegetables, whole grains and legumes. Be sure your child’s intake of dairy food does not exceed recommendations, as this may worsen constipation. Dairy foods include: milk, yogurt and cheese. One serving is equivalent to: 8 ounces of milk or yogurt, 1 ½ ounce hard cheese, 2 ounces processed cheese (American) and1/3 cup shredded cheese. Age Recommended Dairy Intake 1 - 8 years 2 servings 9 - 18 years 3 servings Activity and Exercise: It is important to encourage your child to actively play and participate in physical activity daily. Being physically active helps prevent constipation by stimulating peristalsis, which moves stool through your child’s bowel. An important step to encourage physical activity is limiting your child’s use of television, computers and video games to two hours per day. A physical therapist can help you find ways to increase your child’s physical activity and provide information about community agencies offering recreational activities to children with physical disabilities. Your social worker can also provide these resources. 4 Tips: Your bowel program is a lifelong commitment. Here are some tips to remember: • Maintain consistency with your child’s bowel program. • Eat fruits and vegetables every day. • Your “daily sit,” medications, nutrition and activity are key to a successful bowel program. Notes: Be sure to discuss your nutrition plan with your child’s physician, dietitian and health care team. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5 .
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