Children with bowel emptying problems

Gunilla Tibbelin is a urotherapist at a children’s rehabilitation centre in Lund in southern Sweden. She and her colleagues meet all the children in this region born with spina bifida, some 80 between the ages of 0 to 20.

Almost all children born with spina bifida need help in emptying their bladders and, in time, learn how to use the CIC (Clean Intermittent Catheterisation) method. From the very beginning, many of the children have a reduced ability to empty their bowels due to reduced peristalsis (= bowel movement), weak sphincters and the absence of normal bowel filling. This is why these children need help in emptying their bowels - and that is where Gunilla can help with individual diagnosis and treatment.

Becoming an independent child
"The goal of the bowel emptying scheme is to avoid constipation, to be able to decide when and where to empty one’s bowels, to empty regularly and to avoid leakage in between," Gunilla explains. "In the long run the child should become independent. It’s very important to inform the parents about the risk of constipation as early as possible. As long as the child is breast-fed, there’s normally no problem, but as soon as it starts getting solid food, the parents should be aware of the problem."

Individual evaluation
"It is also very important to evaluate each child individually, as no two children are alike," Gunilla continues. "The ability to empty one’s bowels is dependent on many factors. Before deciding on what type of aid to try, it’s important to look at the child’s current situation: diet, physical activities, fluid intake and good toilet habits. Find out if the child’s diet is well-balanced and if the child tolerates the food it eats. Some children do not tolerate whole wheat gruel, for example, so the parents need to feel their way to find out what’s good for their child. It’s important to create good eating habits that work well for the bowels."

Conservative aids
"As early as the age of one it may become difficult for the child to empty its bowels," explains Gunilla. "Among conservative aids there are laxatives, which soften hard faeces and lubricate the rectum, making it easier for faeces to pass, or anal irrigation with water, which flushes a bit higher and therefore empties a larger part of the bowels. Regular irrigation with water is an effective method of emptying the bowels, and using Peristeen is time-saving and effective for many and gives them a feeling of being completely empty." (Peristeen Anal Irrigation is a complete system providing a controlled irrigation processAnal Irrigation is a complete system providing a controlled irrigation process)

Leakage problems
"Some children experience leakages. It’s a good idea to empty the bowels as much as possible using anal irrigation and then use an anal plug to avoid leakage afterwards. Normally you irrigate every other day and use the anal plug as a supplement in between. You can use the anal plug for special occasions, when going swimming or on a trip for example - or you can wear it for a whole day at a time."

Start training early
"It’s important to train bowel emptying as early as possible," says Gunilla. "A small child manages small tasks; an older child grows with responsibility and can manage more. This also helps increase the child’s self-confidence. It’s a good idea for the parents to follow the child’s development. It’s easy to introduce habits when the child is small. As with all other children, you start off with potty training, getting it used to sitting on the toilet and making sure they go to the toilet every day, right after a meal for example, when the emptying reflex is activated. The goal is to get the child involved in its bowel emptying.