Bowel Training Program for Chronic Constipation

Chronic constipation results in stool becoming impacted in a hard mass that enlarges the rectum. Liquid stool then can leak around the stool blockage and cause soiling. Without intervention, the cycle of constipation and leakage will continue. Stool leakage due to long-term constipation is known as encopresis.

Parents and children often feel frustrated and embarrassed by stool leakage, especially once a child becomes school age. It’s important to know that it’s not your child’s fault and your child isn’t doing it on purpose. There is no shame or blame. 

Children who have soiling or bowel leakage suffer physically as well as emotionally. Many parents and children don’t know what else to do or where to turn. We are here to help.

Constipation and bowel accidents are medical conditions with complex causes. That’s why there’s not a simple, quick fix. However, through our experience, expertise and compassion, our Chronic Constipation Clinic team has been successfully treating kids with bowel issues for more than 10 years.

Through our Chronic Constipation Clinic, we offer a specialized Bowel Training Program created just for children who have been struggling with chronic constipation and bowel leakage for a long time. Through five points of treatment, we focus on teaching parents and children new habits to increase toilet use and decrease stool leakage.

Our team’s comprehensive, multidisciplinary approach includes a clinical evaluation of your child and family by a pediatric physiatrist (physical medicine and rehabilitation specialist), psychologist, and pelvic floor therapist.

 
Our outpatient clinic team includes:

• Physiatrist (medical physician who specializes in physical medicine and rehabilitation)
• Pelvic floor therapists (PT/OT)
• Psychologist

The Chronic Constipation Clinic at Ranken Jordan helps children ages 5-21 who struggle with chronic constipation or experience stool leakage for months or even years.
 
Many of the children we help have already tried medications or even been hospitalized only to find the issue has returned. Children and families are often frustrated, embarrassed and concerned when they come to the Chronic Constipation Clinic. Families may be surprised to learn that other children struggle with this condition too.

Referral to our clinic will come from your child’s gastroenterologist, who is a doctor who specializes in conditions that affect the digestive system. If your child hasn’t seen a gastroenterologist, we recommend that your pediatrician or primary care physician make that referral to a gastroenterologist first. The gastroenterologist will fully evaluate your child to ensure there isn’t a medical condition that requires treatment before starting our program.

Once we receive the referral and your gastroenterology records, someone from our team will contact you to schedule a clinic appointment.

In our clinic, you and your child will meet with a physiatrist, a therapist and a psychologist to gather your child’s history and to determine your child’s specific needs. We’ll also discuss a treatment plan.  

Please fax all referrals (including gastroenterology records) to 314-291-0442.

Our program emphasizes five essential treatment points:
1. Fluid and fiber goals
2. Timed toileting
3. Daily documentation
4. Medication
5. Pelvic floor therapy, including exercises to improve strength, muscle control and body awareness. Therapeutic modalities may include biofeedback and interferential stimulation.

The unique, effective Bowel Training Program is designed for your child’s specific needs. Depending on several factors that we will discuss in clinic, your child’s program may be addressed in an outpatient setting or inpatient setting.

The outpatient Bowel Training Program can include outpatient pelvic floor therapy, clinic follow-up, and psychological support. The frequency and intensity of outpatient intervention will depend on your child’s unique needs.

If our inpatient Bowel Training Program is right for you and your child, we will discuss admission to Ranken Jordan. The length of stay is typically five to eight days. A primary caregiver should be present during the admission to participate in the program and address concerns about following the program at home.

The program will emphasize the five treatment points and will include multiple pelvic floor therapy sessions, consultation with physiatry and psychology, dietary support, and the opportunity to meet with our social worker. Children also will have the opportunity to engage in recreational activities while admitted.

Your child’s treatment with our therapists will involve exercise techniques to address core and pelvic muscle awareness, strength and control.  These muscles are important for bowel elimination.

Biofeedback is a tool our therapists use to help children gain more body awareness and control of their pelvic floor muscles. Children are able to see a visual response on the biofeedback device when they correctly activate pelvic floor muscles. This therapy helps children identify the appropriate muscles needed for healthy bowel control.

Our team is proud of the life-changing success children experience in the Bowel Training Program. Through the program, you and your child will receive a personalized plan of education, therapy and emotional support to regain confidence and reduce stress.
Some of our success stories include:

• Lily was a 5-year-old girl with a history of autism and toileting phobia. She struggled with using toilets outside of her home. Part of her treatment plan was introducing her to various bathrooms. Along with therapy and her family’s support, Lily was able to earn rewards by participating in successful repeated exposures to new bathrooms and ultimately accessed facilities during a beach vacation.
• Marcus was resistant to taking his bowel medication because it tasted “gross!” Part of his treatment plan included learning how to swallow pills, which allowed him to avoid the taste of liquid medication, become compliant with daily bowel medicine, and therefore have less constipation.
• Nellie earned points toward buying a waffle maker by successfully following a toileting schedule at home and school. She also had no accidents for the second half of her third-grade year!
• Maxwell and his mother were able to meet all five major treatment points, transition to underwear, and have significantly fewer stool accidents.