Enemas for Bowel Management 101

Ha, pretty funny title for a clueless lady.

I am hoping it will be a dummies course for ME!!!

So as I mentioned in a comment on another post, I tried to get my head around the whole enema thing and found the task more difficult than expected.  There is certainly no website that I can find that lays out all the options, with pictures and explains when and why to use each one.

So that being said, here are my questions:

1) What are the basic types and benefits of each?  Is it a progression things, start with this, then when ready move to this?  Or is it a preference thing?  I’ve seen reference to fleet, cone & balloon.  Are there more?

2) If impactions are often high due to very slow motility, how does an enema help if it doesn’t go very high? Do most people continue taking laxatives/stool softeners in conjunction with their enema program?

3) Could Camilla’s baby cone be used in lieu of a Miralax clean out or ER run in an emergency?  Or is it not as effective.

See, I’m lost.  Enemas for Dummies, anyone?

37 comments

  • I’m not expert but I’ll give it a try. 🙂

    1) As far as I know, I’ve only heard my local nurse use the baby cone. She is a poop expert, seriously! Fleet is only a temp solution and the elements in it are bad to use over a long period of time. I believe the balloon helps keep in the liquid better than the cone but not sure what benefits the cone has over the balloon other than I would *think* the cone is less invasive and there is less risk for any stretching of the sphincter.

    2) Most people (including us) still need to use supplements etc. We use senna to bring stool down the colon and the enema to flush it out. Less supplementation is needed with the peristeen since it flushes up higher.

    3) Probably not. Impactions are typically higher up in the colon. I’m sure it would help but not take the place of the other two interventions you mentioned.

  • In order for a cone to work well you kind of need the poop to be on the slow side because you want it to stay there until you flush it out. Then there’s no risk of an accident. So I wouldn’t recommend supplementation with an enema.

    Cone you have to hold in (or sit in a way that it stays in) while the balloon, in theory, stays in itself. I don’t know how realistic that is for kids with loose sphincters though. I think it’s preference and what works best for each kid. Once something works, why mess with it?!

    Depends where the blockage is in an emergency. With a regular bowel program I don’t think theres much risk for that happening but most likely shed end up on something oral.

  • Ok. Here’s my contribution. Disclaimer: This is more about what I have read than what I have tried. Still, I hope it will be helpful.

    Here is a really basic diagram of your colon.

    colon diagram

    The basic premise is that the further you can flush the better. Most of the time an enema can fully flush the descending colon, particularly on a regular program. Doing so allows everything to continue moving, and in the case of our kids to hopefully achieve some continence by flushing out enough that it will take a full 24 hours (or more) before everything has moved down again enough to potentially cause an accident.

    To answer your second question, I would think that if the individual is able to move stool within reach of the enema’s action, without supplementation, then that would be ideal. Else you might have a situation where the stool is too soft and you have accidents, as Lauren suggests, However, I know we also have mom’s on here whose child has impactions further back into the transverse or even ascending colon. In those cases then no, the enema alone wouldn’t help. And yes, I would think you would need a supplement to get the stool within reach of an enema. I think you could still achieve continence this way, but it would take a little work to figure out how much supplement was enough without being too much. I don’t know if there is a “most people” answer to this one since everyone has different anatomy and is differently affected. So far at least, Z falls into the former category.

    Kinds of enemas –

    The most basic is the Fleets variety. They do make “enema bulbs” which is the same idea. And the Fleets brand comes filled with a solution that includes phosphates. Phostphates are not really recommend for children, and even with adults should not be used regularly. These, a bulb or a bottle, are just a small, squeezable container with a nozzle and a valve that prevents the container from drawing back liquid into itself. (So, it only can squeeze out, not suck in.) The squeezing action pushes the water in and provides what “force” there is.

    You fill the container with whatever solution you are using, insert it and squeeze. The best results are aided by placing the child on their left side so as to most effectively move the fluid through the colon. Once the solution is emptied into the colon, you wait a few minutes to give it time to work its way as far as possible, then sit on the toilet and allow time for it, and all the stool involved to wash back out.

    With our kids, certainly with Z, the issue with this style is that the nozzle is slender and without tone to keep the fluids in, they just flow back out before they can be effective. Part of the reason the cone enema is popular is that the cone counteracts that by its shape.

    A cone enema uses a fluids bag, tubing, the cone itself and gravity.

    cone enema

    The process is essentially the same, but rather than relying on a good squeeze for momentum, it uses gravity. So the bag is generally hung 3-5 feet above the individual to make the most of the effects of gravity and can be raised or lowered to increase or decrease that effect as needed. As Lauren mentioned, you could do this while seated on the toilet, rather than lying down (at least with an older child and greater fluid volumes than us), because the force is greater and the lying down doesn’t have as much impact. The recommended wait time before removing the cone, at least that I have seen, is 10 minutes.

    So why did I chose the Fleets bottle? Well, I’m only using about 2 ounces of water, so the cone seems a little overkill just yet. We are using the bottle *instead of* a syringe (as shown on the other thread) for two reasons. Primarily, I had the bottle already. 😉 Also, 2 ounces in a syringe is a heavy syringe and I have a wiggly baby. I’m using an (adult size) bottle because I can get a good firm hold on it even when she wiggles. The bulb syringe just becomes my cone/stopper and works really well. I’ve uploaded a photo. There are two bulb syringe pieces in that photo. They both work, and I prefer the smaller- easier to manage – more tapered and suitable for her size.

    Currently I am using two ounces of warm tap water. That is all. I have her lie down on her left and I leave the solution in about 2 minutes and then put her on the toilet for about 20 minutes. That is all less than what I read elsewhere as being “standard” but she is only 16 months old and much younger than the intended patient group that the literature assumes. This is sort of a mini/starter enema that she will absolutely outgrow.

    At the point at which she is too big for this we can move to a proper cone program or a balloon catheter variation. You could do this with a foley, still using gravity and the other general guidelines or, you can try the Peristeen.

    The Peristeen does not rely on gravity, but on a squeeze force like the bottle/bulb. It’s designed to be set on a counter and need no “rigging” (where to hang the bag). It also does not require that you hold the fluids in because you are pressing the water up, not waiting on gravity. I’ve also read that those who have had success with it are able to flush up into the transverse colon, which would (theoretically) give you a longer “clean” period.

    peristeen

    The Peristeen is a catheter that is inserted, with a balloon attached. You basically insert the catheter (a one time use supply that would tossed and replaced with each use), turn a switch to an “air” setting and pump air into the balloon. Inflating the balloon is what will hold the catheter in place. You then switch the setting to “water” and using the same hand pump (an inline bulb) pump water through the catheter into the colon. Once you’ve infused the amount of water/solution required, you switch back to “air” which deflates the balloon. You remove the catheter and allow the fluids to flush out as you would at the end of the other enemas.

    Problems with the cone system, to my way of thinking, are just the need to have some way to hang the bag and the additional time while waiting on the fluids to work into the colon. I also don’t think, all things being equal, that it will flush as far as the Peristeen and the most effective use of gravity requires lying down (not absolutely necessary but the most recommended for highest performance) and then transferring to the toilet. None of these are a big deal. I would put these into the category of preference, knowing that the preference can be driven by what works best with an individual’s anatomy etc.

    Negatives with the Peristeen would be the initial cost, a need to replace a catheter each time (cost) and the possibility of the balloon either not sealing or bursting. In an older person, I would think these things would be a bit more nuanced (perhaps a greater awareness of how well the balloon is working ). In a child, the rule is that if it isn’t leaking, its working. I have read complaints from adult users that balloons have burst while inserted. That can’t be pleasant and could be terrifying to a young child. It could be user error. It could be an occasional quality control issue. In either case I wouldn’t use it until I could really communicate more fully with Z. But again, I would think this is largely preference based with the same caveat as above.

    I hope we are able to transition to the Peristeen. If it were me that needed this daily, I would rather have that. I like the idea of being able to more fully flush, my visual driven self would rather not have to set up a permanent place to hang up a bag (more medical and I’m of the bathrooms-should-be-like-spas mentality – my own hang up, I know.) and honestly, I’ve read a lot of testimonials from adults who prefer this system to other enema systems. That being said, if it won’t work for us then it won’t. The cone system is hugely successful for many, many people. I’m not discouraged either way.

    I’ve used links because I couldn’t figure out how to get multiple photos in the one post. Admin, feel free to edit to place them in directly.

    Also, here are links to a series of videos CHoP did, that I thought were very basic and helpful.

    Hope that helps!!!

  • (Fleets bottle w/bulb syringe)

    baby cone

  • Thank you all very much. So so helpful.

    One final question. So what is the standard protocol for the great majority? The SB clinic/GI/Pediatric Urology Protocol? Miralax until 2 or 3, then cone enemas after that?

    And does that protocol differ from the protocol recommended at the 2, or is it 3 now, Bowel Management Programs?

  • I am not certain that there is a universal standard. Certainly many doctors do recommend the miralax, but if you recall, in one of her comments elsewhere, Dana mentioned that the clinic in Cincinnati told her that they specifically do not recommend it. I know another mother stated that it was her physician who recommended milk and molasses as an enema solution. I think from Dr to Dr there could be rather a lot of variables.

    As for the bowel programs themselves, I believe the two in Ohio would be identical since they are run and set up by the same group of folks. I suspect that other clinics elsewhere in the country are largely following their protocol. But, I have not been to any of those clinics nor spoken to them. So, I couldn’t say for sure either what their standard is or how that would vary from an individual doctor’s.

  • there is also a balloon gravity enema, which is what cincy prescribes. The “balloon” portion is the foley catheter, and the gravity portion is a feeding bag with a valve to regulate the flow of solution. You don’t really need a “permanent” place to hang it, as a hanger from the shower rod works fine. I know some places (like Camp Independence, the SB-specific summer camp) has communal bathrooms with MACE hooks for whatever contraptions a person needs.

    They way it stays in is by blowing up the balloon on the foley using a syringe. Cincy initially recommended 20-30 ccs of air, but Meredith needs from 40 to 60 ccs due to no anal tone. anectodal evidence indicates this is a lot! Then you infuse in the solution, just like for the cone.

    The reason why Colleen and others recommend the cone over the balloon is that it is something that can be purchase without a script from amazon. foleys and feeding bags cannot. Many people cannot or do not want to go to bowel management program and so that is how they can perform a gravity enema without a medical professionals input.

    • The CHoP videos cover this too. I would think that, just like with the Peristeen, this also has the advantage of not having to be held in place by hand.

      • Actually, to keep from leaking, the balloon needs to be tugged on a bit (but not hard enough to pull it out). We have Meredith lay over a wedge pillow for the infusion + holding time (we infuse it over about five minutes. this is regulated by the valve on the feeding bag) and then hold it in for 10 minutes, all while we’re tugging on it. then transfer her to the toilet, deflate the balloon, remove and then sit for 45 minutes.

        I believe this is an advantage over the cone, which has to be held in by hand. It seems a lot of people place the child on the pot and hold it in that way, which would be very awkward to do for 10 minutes. It seems a lot of them get a special commode so there is space between the child and the regular toilet seat for their hand.

        This method is working for us know, but I’m sure you can see why we are hoping for the peristeen eventually. Sometime (soon!) she’s not going to want to be lying on the bathroom floor with her butt in the air while I, or especially her FATHER, is administering the enema! For now it’s fine, but … And if she decides that a MACE is actually her preference, I will support that too (I think.)

        • All of the people I know who do the cone (us included) just use a regular potty seat and the child leans forward. No transferring and no specialized potty seat. Have you tried doing the whole process on the potty? I have a friend who just sits the child on the side of the potty seat so that the seat holds the cone in place and no one has to hold it in. Just in case you’re looking for other options 🙂

  • What a great thread for future reference purposes. Thank you ladies so much.

    Now if I could just get that lazy admin to upload those pictures!!!

  • Hey look! That lazy admin got it together! 😉 Actually, I would have done it myself, but I didn’t get an option to use HTML from a reply. ???

    Just wanted to add that last night I made a couple of changes. I switched to saline (1 1/2 tsp salt per liter per Cincy’s documentation) and added a suppository’s worth of glycerin. She had still had a little poop between enemas the previous days. Not a big deal since we are still in diapers but I wanted to see if I could do things a bit better. It did seem to eliminate that, at least so far.

    So, just for reference, the general protocol I’ve read (for older kids) is 10ml of saline per pound. Z is 26 lbs which would be 260mls/8.7 ounces of saline. I only used about 4 ounces yesterday. I had been using 2.

    That also taught me another handy benefit of the bulb syringe. I started with two ounces last night and was able to remove the Fleets bottle, holding the syringe in place and blocking the small opening, refill the bottle and add the additional water after the first ounces had been infused. That wouldn’t be universally necessary, but it was helpful to me last night.

    Hope this helps someone else too!

  • Just wanted to revisit this briefly to say we were at clinic yesterday. No oneven had any concern at all that we were using an enema as a bowel management tool.

    For reference, Z is currently 27 lbs, 32ish inches and 17 months.

  • Just a quick update on our foray into this arena. We had upped her total fluid amount to roughly 8oz (or the 10mls/pound recommended by Cincinnati). After a few days at the lesser amount we just weren’t getting anything. So basically I was using to Fleets bottles and switching them wasn’t hard, but it was just sort of a pain.

    So… We purchased a proper cone kit. Yesterday was the first day with it. It was a lot easier to use than the bottles. I was surprised. It was more fiddly in some ways, but less in others. Interestingly, where Z had always shown she noticed with the other method, she seemed completely oblivious to this. Maybe she’s just getting used to it, but…

    We also will clearly need to increase the time she sits after. Still tweaking that. I took her off yesterday after 30 minutes. We had somewhere to go. It was obvious she wasn’t quite finished, but I just slapped on a diaper and kept going. That turned into a seriously messy diaper (no solids but lots of nasty liquid) that leaked and got on clothes, etc. over the hour or so. Obviously I’m not going to have her sit for 90 minutes, I don’t really think it needs to take that long anyway, but she’s still small enough that we can use a diaper and no one with think a thing of it.

    All for now.

    • Overtime, the time C has to sit on the toilet has decreased significantly. Now she sits for 20 minutes but she is mostly done after 15. She uses a squatty potty which I assume would be too large for Z but if you look it up, I’m sure you could figure out something that works similarly. Also, even though I know its very limited, its worth teaching her how to push (growl, cough, etc) and having her reach for toys etc while on toilet. You can also massage her tummy a bit. Anything to try to get it out faster!

    • Did you add an irritant like glycerine or soap? I bet (if you didn’t) that would help Z get it out faster.

      When we were first learning at Cincy, we had to turn the glycerine down because it was cramping Meredith. Now that we’ve been at this a while (one year in July!), we’ve been ramping it back up. This moves the poop much faster. I’m attributing this to her getting used to whatever sensation, as well has her rectum healing over this time. They start with 10 mLs per pound of body weight at Cincy. She was a little over 40 lbs so we started with 40 mLs of glycerine. We left using 15 mLs and now we are up to 25 or 30 mLs.

      I might have mentioned this already, but according to Dr. Bischoff, colons are like fingerprints: completely unique to each person. Which is why each kid responds to their own unique formula. Meredith has a “petite” colon, and according to Colleen, Nates is made of steel!

      P.S. I would be happy to scan and email the binder Cincy gave us for home reference if anyone wants it. Just email me at klgs24 at frontier dot com. It would be next week sometime.

      • I actually am using glycerin. We were already using it with the suppositories, so it seemed sensible to use it here. I’m using only about 10 mls though. Might try increasing that.

        I’d love a copy of what you have. I’ll email you later this weekend.

  • It’s funny how we moms are so different. I would mix concoctions like a mad scientist whose life depended on it to avoid a scenario like that.

    I don’t know what it is about the enema scenario that I am so opposed to – the time? the mess? the clean-up? IDK?!?

    But I know it doesn’t phase you a bit!

    Isn’t that funny?

    • I bet you’ll come around. 🙂

    • Aw, come on, let the poor old woman enjoy a good dose of denial, will ya?

      Just kidding. I know, I know, enemas are in my far & very distant future. 😉

      • I was freaking about enemas too. It really is scary, and has overtones of sexual abuse (in my head at least). However, Meredith was at the point where she was going to pre-school and having accidents and kids on the bus had started to tease her about it. Apparenlty our kids become used to the smell and they can’t really feel it on their behind, so you would ask her if she was poopy and she’d answer completely innocent “no!” And she’d have a load. It was becoming when anyone at day care or on the bus smelled something stinky they’d tease that “Meredith is poopy!” and it was very distressing to her, and breaking my heart. So I was willing to do ANYTHING to change that. We were even recommended the MACE, but my husband and I wanted to try something else first that wasn’t creating a permanent hole in her body.

        • Its funny you say that, about sexual abuse. I get it, but I really never thought of it that way. But then, when I was researching bulbs and supplies I came across a lot of fetish sorts of things. Not exactly surprised, but still… Then again, people have made a sexual “thing” out of all manner of otherwise ordinary, non-sexual things.

          In any case, I don’t want her to ever think of it as something scary, or icky or what have you. I think that would make it easier for someone to take advantage of her somehow (God forbid!) if she was already feeling some manner of embarrassment or shame about it.

          I’m grateful it really doesn’t bother me, because I wouldn’t want to transfer that to her somehow. And actually, today, her big brother helped keep her entertained. We insisted on an age appropriate amount of privacy when we got started, but I answered all his “What’s that?” questions, and let him keep her company while she sat. It was very sweet to see him want to be there with her.

          I totally share your feelings about the MACE. More, since we have several years yet before continence is any sort of issue (and we will home school, so probably have longer than most) I am curious to see what else may develop between now and then.

          ETA: None of that is to suggest that I think you are wrong for your thoughts about it. If anything, I think I’m the odd man out on this one. It totally freaks my mother out too. Just made me think of all the “extras” I found researching supplies. And then, you know, I can’t shut up. 😉

    • It is! I really had no intention of starting this soon, though I fully expected to do it. And it really does not bother me, but…

      I opted to do this because the supplements weren’t keeping up. Every time I’d get things where I was happy with them, something in her diet would change and we’d be back to starting over. It wasn’t like that in the beginning. Not at all. But she’s been such a good eater from the start and the older she is, the more varied her diet is and the goofier this all became. While I’ve never worried that we keep her colon completely clear (don’t think that is really normal for anyone) she was starting back up every few days. I don’t want that for her either. We’d have one good day, maybe two, then an iffy day and then three days of constipation – and repeat. That’s not ideal either.

      This is so direct and simple. I know exactly what is happening. The results are instant and then we all move on. I don’t have to worry about stomach cramps or wonder if things are clearing out. I just plain know.

      As for the mess/clean up, its almost nothing. Certainly it isn’t any more effort or mess than the suppositories. So that’s a whatever. It does take more time all at once, though probably not more overall (if you add up all the time to mix, apply, check diapers, wonder if, change supplements or ratios, repeat etc.). That will get better. For one thing, once she is a bit older I can just check in on her and not have to sit with her for the whole time. Even now sometimes her big sis or her dad will take a turn keeping her company.

      Camilla, I suspect that once we do this new routine for a week or so things will adjust and she won’t need to sit that long. I love the squatty potty! But she’s so small now that by the time you add in the soft potty seat, her little feet barely reach the top of the bowl. (It is adorable and ridiculous!) We do set her up with things she has to reach for, and play silly, giggly games. I’m sure that helps.

      Either way, for now 30 minutes is about her tolerance limit. Since we aren’t doing this for continence just yet, it really doesn’t matter. I’ll let her sit past 30 if she feels like it, but once she gets frustrated we will just put on a diaper and keep going. By the time she’s old enough for there to be a concern about accidents after, I think it will be a non-issue.

      Oh Tspar! That is one other reason I am happy about starting now. She will never need to adjust to the idea. I think, if she were a few years older before we started there could be some real unhappiness at first. Plenty of mom’s over on BBC commenting about bribing their kids to get started seems evidence of that. Right now she couldn’t possibly care less. Later it will just be what we have always done.

      Its really and truly no big deal.

      • Good food for thought. I definitely don’t want it to be negative for her in any way, due to her age or my negativity.

        But I still hold out hope that she can be bowel continent without it. But if not, we will embrace it and make it her new normal.

  • So… We had a very strange (and scary) incident this week that landed us in the hospital overnight. It’s still a bit of a mystery, what happened. But!

    While we were there, they did a belly Xray and it is evident in the images and spelled out in the notes that we had no constipation or abnormalities. So, yay!! Clearly this is working for us.

  • I just wanted to chime in and tell you ladies thank you for all the wonderful back and forth, advice and encouragement for each other. I am rereading everything and preparing to start Korie sometime in the next week or so. I am torn between just using the fleets bottle or go all in and use the cone.

  • I say start with the bottle. Its far less investment in time and money. Sort of a “trial” of the bigger process. It will give you the chance to get over any nervousness and discover any issues she might have. You’ll feel more prepared to move to the cone and you can take your time getting your supplies together.

    I’m actually glad to come back and re-read this. I should have done it ages ago. All of this is a trigger for whatever dyautonomia Z has going on and looking back over this gives me exact dates. That helps me prep for our visit back to Boston next month. I hate that we aren’t able to keep doing this now, though. It may be Mace for us after all. So strange..,.

    • I have actually used the bottle several times for those days that her bowels were being stubborn and the little glycerin didn’t work. I have a hard time keeping the water from just flowing back. I need to look into how you attach the bottle to the bulb syringe.

  • I just cut the bottom half out of the bulb and about an inch or so off the tip and slip it over the bottle nozzle. It should basically slide low enough on the bottle that you can insert the two together with primarily the bottle nozzle being on the inside and the syringe is like a little sword hilt at the bottom that would rest against her little bum and keep the fluid in.

    Hope that makes some sense!

  • We tried the bottle once or twice, but really, really glad we went ahead and switched to the cone. So – my vote would be to go straight to the cone. -OR- just don’t get frustrated with the bottle and give up on the whole thing. With the bottle, for us, it was hard to keep the fluid in for long enough, hard or impossible to administer while sitting on the potty, super dirty to do laying down and then try to transfer to the potty…just a general fail for us!! The cone is so, so easy to setup, cleanup, and administer. For what it is worth, one vote for jumping straight to cone! 🙂

    As an aside, MrsK – I will be anxious to hear about Z’s visit next month. Keep us posted!

    • Being able to administer it on the potty is what appeals to me about the cone. But I can’t imagine holding it there for up to 10 minutes. How do you handle that? K is fine on the potty, she has a Rifton toiling system so she just sits there and plays, Im worried about me getting bored for the 10 minutes!

      • I hear you, for sure. Sometimes 10 minutes can seem like forever, especially when there are a million other things that need to be done. However, I have found that I actually really love potty night. The 10 minutes of holding the cone in place (which is now only 8 minutes for us, and we will reduce to 7 minutes this week) gives me a chance to really slow down, sit still, and play with my daughter one on one. She has a little table in front of the potty – nothing special, just a TV type table that I cut the legs to the proper length and it nicely tucks away when we are done – and we play cards, learning games, leggos, play dough, etc. The 10 minutes goes by really quickly. Then she can sit, is usually entertained by her sister, and I can get up to do my chores and such. However, to be quite honest, I love the sitting time too and often will find myself continuing to play and play. It really all goes so fast – both pooping and just growing up too fast in general!

        As far as the awkward holding of the cone, well it is not really that big of a deal at all. Your hand gets used to the proper angle to hold it in place and not leak water, you kind of rest your arm on the potty seat, and it is over before you know it. You learn quickly how to pull the cone out without getting any poop water on your hand. My kiddo knows the whole drill – she leans forward for placement, knows what the timer dinging means and leans forward for removal. She is even starting to be able to communicate if she has more poop that needs to come out or if she is all done – most of the time she is right!!

  • Okay ladies, I am not sure our first night was successful at all. I am now a little worried. We did the cone, about 250cc water and probably 15 ml glycerin. Went in fine, held it for about 6-7 minutes. Not a ton of stool came out, she sat for about 20 minutes. She was acting weird. Like drawing her arms up to her chest and her color changed a bit. I think she is probably more constipated that I thought, but she did pass corn the day before within 24 hours of eating it and has soft stool. Anyway she spiked a fever about an hour later, she sounded really wheezy and had some crackles in her lungs. She has had a small cough but nothing like this. Around10 or so her temp was 102.6 So i gave her Motrin, put her to bed prepared to call the pedi this morning but she woke up fine. Is this a coincidence or could they be related? I am way too nervous to try again tonight. I think if she could verbalize to me better if she was uncomfortable it would help. Any thoughts?

  • So… I say wait. Just wait.

    We have had some issues with this that I did not anticipate. Much scarier than what you are describing, and I really thought (and still think) that it was something with Z. We are pursuing that something pretty seriously. But even though I don’t think the enemas are the cause, they certainly are the trigger. Without them we have no issue, well other than bowel issues.

    It may be something we aren’t able to pin down. It might be something we outgrow. But at this point, I can only encourage you to err on the side of caution. Once she’s big enough to truly tell you what’s up, then it will be worth another try. I recognize that this, enema routine, is the standard solution. I understand and agree with that. I still have my sights set on the Peristeen. I wanted very much for this to work starting very young so we would have no issue transitioning later. For us, this time, I don’t get what I want. At lest, not the starting young part.

    I have hesitated to say much in the forums. I don’t want to frighten anyone. I don’t think that our issues are related to SB and I think that if we didn’t need a bowel routine we’d never know there was any issue at all. I don’t want to scare anyone away from enema’s either. For a vast majority of kids, this is the real path to independence. I don’t want our strange situation to be a roadblock for someone else.

    But IF you are having an issue, my serious advice is just wait. Don’t rush. Don’t push. Go back to what you were doing before. Wait a while. That’s what we are doing, at least for now. When I know more, I’ll share it.

  • Yikes! Oh no, so sorry that happened. We all struggle with that dance of “is it because of SB or something else”. I agree with MrsK to wait on this one. Make sure she is feeling great again before giving it another go. Maybe try less volume, baby soap instead of glycerin, saline solution instead of water, more time between eating and enema, etc. I would also be calling my urologist or, if you are lucky enough to have a good one, a pedi gastroenterologist, just to make sure there is not a contraindication to the enema routine.

    Hang in there and keep us posted!

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