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Bowel management is a medical approach to manage fecal incontinence or constipation.〔Ramon S Lansang (Bowel Management ) eMedicine May 7, 2008〕〔Marc A Levitt (Constipation and Bowel Management ) eMedicine August 27, 2007〕 Bowel control is often a challenge for children who are born with anomalies in their anus or rectum, Hirschsprung's disease, and/or spina bifida. Some patients have a poor prognosis and will never be able to control their bowel, and so benefit from bowel management techniques. == Overview == Bowel management is mainly achieved through a daily enema which empties the colon to prevent unwanted and uncontrolled bowel movements that day.〔Peña A, Guardino K, Tovilla JM, Levitt MA, Rodriguez G, Torres R Bowel management for fecal incontinence in patients with anorectal malformations Pediatr. Surg. 33:1 133–7 1998〕 Some people also use laxatives and a controlled diet as part of their bowel management regimen. Another alternative is transanal irrigation. Transanal irrigation of the rectum and colon is designed to assist the evacuation of faeces from the bowel by introducing water into rectum via the anus.〔(), Consensus review of best practice of transanal irrigation in adults A V Emmanuel et al Spinal Cord 2013.〕 By regularly emptying the bowel using transanal irrigation, controlled bowel function is often re-established to a high degree in patients with bowel incontinence and/or constipation. This enables the users to develop a consistent bowel routine by choosing the time and place of evacuation.〔 An international consensus on when and how to use transanal irrigation for people with bowel problems was published 2013. The article offers practitioners a clear, comprehensive and simple guide to practice for the emerging therapeutic area of transanal irrigation.〔 Determining the appropriate regimen to achieve successful bowel management is done under medical supervision. Care is tailored to suit each child and often requires a trial and error approach over the course of a week. The patient has an X-ray taken which is reviewed by their doctor. The doctor then recommends a course of action (e.g. enemas, laxative, and/or controlled diet). The next day, the process is repeated with modifications to help the child achieve a completely empty colon. After the course of this week the doctor can determine the precise amount and combination of what the child needs to achieve bowel management. From then on the patient can continue the regimen on their own.〔 Bowel management does not cure fecal incontinence, but can greatly increase quality of life. With successful bowel management, a child may be more apt to establish independence in normal daily life. Children with severe incontinence may also be able to attend school and participate in activities they otherwise would never be able to.〔 Depending on the prognosis, some patients will continue using these techniques for life while others may gain some degree of bowel control and become "potty trained". Children who practice bowel management often become unhappy as they age, especially at puberty, due to feeling that the administration of enemas is an intrusion on their privacy, especially as it is difficult for them to administer the enema themselves. An operation called a continent appendicostomy or ''Malone procedure'' is available. This allows a person to give themselves an enema by inserting a catheter into a small orifice at the belly button.〔Levitt MA, Soffer SZ, Pena A. Continent appendicostomy in the bowel management of fecally incontinent children. J Pediatr Surg. November 1997;32(11):1630-3〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Bowel management」の詳細全文を読む スポンサード リンク
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