Pediatric Neurogenic Bowel
Babies wear diapers. That is a given in our society. Neurogenic bowel is a miscommunication of the nerves. Children who are born with or develop neurogenic bowel due to neurological issues require a bowel program which leads to predictable and controllable bowel movements.
Babies are born with bowel and bladder control yet to be developed. It is not an expectation that babies, or very young children will be able to use the toilet. Therefore, it is not uncommon for babies and young children with neurogenic bowel to be diapered with stool overflow for excretion. However, this is not an effective process for evacuation. With neurogenic bowel, stool collects but the bowel does not effectively empty.
The bowel is elastic much like a balloon. The more it is overstretched, the less it will be able to return to an efficient mechanism to push stool through and out of the body. A bowel program is critical to maintain the health of the colon throughout life.
Bowel programs mimic the normal function of the bowel, filling the rectum followed by evacuation. Infants without neurological issues have an average of three bowel movements per day although with the stimulation of feeding, there can be more. By age 1 bowel movements average of two per day. Preschoolers average three bowel movements over two days. If your child does not fit numbers, do not be alarmed as there is a great variance among children based on diet, activity, culture, as well as other factors. Children with paralysis may have a slower functioning bowel.
Usually, a neurogenic bowel and neurogenic bladder are diagnosed together as both bowel and bladder are controlled by the nerves the exit the spinal column at lumbar 4-5 (L4,5). The diagnosis of neurogenic bowel requires a bowel program to completely empty the lower bowel as well as to avoid incontinence.
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Children with upper motor neuron bowel diagnosis most often have a spinal cord injury in the cervical (neck) or thoracic (rib cage) area of the spinal cord or a brain injury affecting motor nerves. The nerves are generally hyperactive (spasticity or tone). Lower motor neuron injury occurs in the lumbar (small of the back) or sacral (just above the gluteal fold) in spinal cord injury, spina bifida, or brain injury that affects lower motor neurons. This creates flaccid of nerves and body.
Your child’s healthcare provider will do testing to see if a neurogenic bowel exists. This is typically performed by inserting their small finger into the rectum and checking for reflexes. Electrical testing is sometimes performed.
Treatments include a stimulant such as a suppository and digital stimulation to the internal sphincter for upper neuron issues. Lower motor neuron bowel is treated with manual removal. The healthcare professional will tell you the frequency of the program for your individual child. When performing the bowel program, look at the length of your child’s index finger. That is approximately how far you will need to insert your small finger into the rectum. As your child grows, you will need to adjust to their size.
Although this seems like a very odd thing to do, currently, it is the way the bowel is effectively emptied to avoid overstretching which is necessary to keep the bowel healthy throughout adulthood. Remember, this is normal for your child.
To learn the bowel program process, talk to your child, regardless of age, about what you are doing. Slowly integrate your child into the process so they will be able to transition when developmentally ready. How children learn and progress is an individual experience. Being self-sufficient by school age is a goal if appropriate for your child. Some process the information sooner than others as each child is an individual. Learning to handle accidents is also important as they happen occasionally due to diet, anxiety, stress, all the usual issues.