This results from disruption of the normal peristalsis due to lack of nerve stimulation within the rectum.
This occurs when pressure inside the rectum produces a reflex relaxation of the internal sphincter without sufficient voluntary control and contraction of the external sphincter (anus).
This occurs if constipation is left untreated and liquid faeces seep through the relaxed internal sphincter. As a result children who present with diarrhoea need to be checked to exclude an underlying constipation prior to instigating any treatment [e.g. loperamide]. This can also occur if constipated and a stool softener is used.
Massive distension of the lower bowel can occur if the child is allowed to become chronically constipated.
Can occur in extreme cases.
Can develop as a result of passing hard constipated stools.
Perianal skin problems can occur as a result of frequent soiling.
This involves the child sitting on the toilet at regular intervals at set times during the day. The best times are after meals which makes use of the gastric-colic reflex. The child is encouraged to push down by increasing intra abdominal pressure. This can be achieved, for example, by asking the child to blow raspberries on the back of their hand or blow up a balloon.
There are a number of options available depending on the childs individual need. For the child who has some degree of rectal sensation - avoid constipation, using laxatives if necessary, and encourage scheduled toileting. For the child with no sensation but the external sphincter [anus] does contract to stimuli do as above but introduce micro-enemas [e.g. Dulcolax suppositories] to facilitate a reflex bowel evacuation. For the child with no sensation and no reaction of the external sphincter - here the anus usually appears lax and patulous. Management involves carefully induced firm stools, using diet/loperamide or similar preparation, a controlled evacuation of the bowel is then carried out 3-4 times per week using enemas or suppositories.
The above are guidelines and suggestions only as all children are different. Each programme will need to be adapted for each individual child and to fit in with the family dynamics.
This involves a procedure similar to a rectal/colonic washout. A large catheter is introduced into the rectum and lower colon and a retaining device attached to the catheter, either an inflatable balloon or cone is inserted into the rectum. A saline solution is then run into the bowel, the amount depending on the size of the child, and retained for as long as possible. The child is seated on the toilet and the cone removed or balloon deflated, the contents of the bowel are then evacuated. This procedure is usually carried out either daily or every other day provided the child remains clean in between.
Antegrade Colonic Enema, initially involves a surgical procedure to fashion a non-return valve, usually from the appendix, to form a small stoma on the abdominal wall which connects to the colon. The procedure then involves the child sitting on the toilet and inserting the catheter through the stoma into the colon. A solution of sodium phosphate [or similar preparation] and saline is then run into the colon, the dose and amount of saline again dependent on the size of the child. This stimulates peristalsis and facilitates a bowel evacuation and washout. The whole procedure takes approximately thirty minutes and is usually performed every 1-2 days depending on the child.
If the A.C.E. procedure was to be a considered option for the child for the future every effort should be made to introduce a bowel management programme that avoided the child becoming constipated. This is to avoid mega colon developing and ensuring the bowel remains in the best possible working order for surgery.
This is an option for the child if all other managements have failed or the child is not suitable for an A.C.E. procedure. A colostomy involves incising the colon and bringing it out onto the abdominal wall to form a stoma. The child then wears an appliance to collect the faeces which is changed as often as necessary, usually daily.