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Colorectal and Pelvic Health Program
Patient Resources
We have a dedicated bowel management team to help your child who has either constipation or fecal incontinence. This team is led by our two advanced practice providers: Veronica Victorian, PA-C and Felicia Denner, FNP, RN. We have a devoted bowel management clinic offered at several locations around Houston and a location in Austin. We are committed to helping your child be clean and continent of stool. We understand that many of our patients live outside of our service area. We will need to meet with you in person for the initial visit. Although you and your family may need some in person follow-up visits, we are also experienced working with families from a distance to help your child attain fecal continence.
What to expect from your visit
We meet in person for your first visit and customize a plan to meet your child’s individual needs. Our team will teach you how to manage your child’s condition with timed bowel movements, enemas, dietary changes, and/or medications, such as laxatives.
We understand that many of our patients live outside of our service area; therefore, we don’t require a week-long visit to teach you how to manage your child’s incontinence. You may need some in person follow-up visits; however, we also have experience working with families remotely to help your child attain fecal continence.
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Minimally invasive surgical procedures can provide better outcomes for your child as they provide less scarring, less pain and quicker recovery time. Our highly skilled and specialized surgeons perform several minimally invasive procedures, including:
Posterior Sagittal Anorectoplasty (PSARP) / Pull-Through
Posterior Sagittal Anorectoplasty (PSARP) is also known as a pull through surgery as it is used to repair anorectal and cloacal malformations. Frequently this procedure is performed completely through an incision in the bottom. For children with high imperforate anus or long-common channel cloacal malformations, surgeons at Texas Children’s Hospital use minimally invasive laparoscopic techniques to help reposition, or pull through, the rectum and anus. Reconstructive surgery is used to create a new anal opening or anus.
What to expect after surgery?
After surgery, your child will remain in the hospital for 5-7 days. He or she can leave the hospital once they are able to eat and pass stools successfully. Before leaving our team will teach you how to take care of the incision on the bottom. At your post-op clinic visit, we will teach you how to perform anal dilations to prevent your child’s new anus from closing due to scar tissue.
Transanal Pull Through
Transanal pull-through surgery is used to treat Hirschsprung’s disease. The entire portion of diseased intestine (the bowel that does not have normal nerve cells) is removed. The healthy intestine is then connected to the anus to allow the body to pass stool normally. At Texas Children’s Hospital, minimally invasive, laparoscopic methods are used, allowing the surgeon to reach the bowel through 3-4 tiny incisions. Occasionally, the entire surgery is done through the child’s anus. With either method, pathologists examine the intestine under the microscope, at the time of surgery, to help make sure all of the bowel that is missing normal nerve cells is removed.
What to expect after surgery?
Most children stay in the hospital 3-7 days after surgery. Children are given IV fluids until they are drinking enough to maintain hydration. After surgery, special care is given to the skin around the anus after surgery because children are likely to have several stools a day, which can cause skin irritation. This improves over time, and we will tell you which creams to use to help protect the skin.
Cecostomy
Cecostomy, also known as a c-tube, is a surgical procedure used to treat children with fecal incontinence. It is used to clear the bowel of feces when other treatment has not worked. Children in need of this procedure may suffer from constipation, soiling, an imperforate anus, spina bifida or other muscular problems.
A tube (catheter) is inserted through the abdomen into the lower part of the large intestine. The tube is held in place with small sutures (stitches). Liquid medicine is then inserted into the tube to flush fecal matter out of the intestines through the child’s rectum or bottom, much like a traditional enema.
What to expect after surgery?
After surgery, your child will remain in the hospital for 1-3 days. We start giving enemas through the tube while your child is in the hospital. Before leaving the hospital, our team will teach you how to administer the enema through the tube, and make sure you have all the necessary supplies set up for home. Once home, you will give your child an enema through the tube to clear their bowels. This is typically done once a day.
Appendicostomy
An appendicostomy (Malone) is a procedure used for children with fecal incontinence including constipation or leaking. Your Texas Children’s surgeon will connect your child’s appendix to their belly button or their lower right abdomen. A valve using your child’s colon is then created inside your child’s belly. Next, a tube (catheter) is inserted into the one-way valve, which will be used to administer an enema to clear your child’s bowels. At home, you and your child will flush liquid medicine (enema) into the tube to remove stool from his or her colon.
An appendicostomy is ideal for children who do not want an external tube or device on their abdomen. After the appendicostomy has healed, in most patients the surgery site is almost invisible. This can be particularly beneficial in school-age children who want to minimize differences with their peers. It also allows children to participate in sports or activities without worrying about having a tube or button in place.
What to expect after surgery?
Most children will stay in the hospital for 1-3 days after surgery. He or she will be given liquids, then solid foods. While in the hospital, our team will show you and your child how to give an enema through the tube. We will also teach you how often your child should flush their bowels through the tube, and make sure you have all the necessary supplies for home. A tube will stay in the appendicostomy for 4-6 weeks after the surgery, while the appendicostomy site heals. After 4-6 weeks, you will come to the clinic and we will teach you and your child how to insert and remove the catheter. Our child life specialists are available at this appointment to help your child understand the process.
Ileostomy
An ileostomy is a procedure used to divert stool from the colon. A part of the small intestine is connected to a surgical opening created in the abdomen (stoma) and feces is then passed through the stoma into a sealed pouch outside the body. Often an ileostomy is temporary, and is in place to protect the colon and bottom from stool before and after anorectal reconstructive surgery. An ileostomy may happen as part of another procedure, or as a separate procedure.
What to expect after surgery?
Your child will stay in the hospital for a few days after surgery. IV fluids will be given until your child is able to drink and eat. Our team will teach you how to care for your child’s ileostomy at home. The stoma will be deep red or pink and moist — that is normal. The skin around the stoma opening can become irritated. We will teach you which creams you can apply to protect your child’s skin and how to properly care for your child’s stoma. We will also make sure you have all the supplies you need to take care of your child’s ileostomy at home.
Colostomy
A colostomy is often used to treat imperforate anus and other colorectal anomalies. A part of the large intestine is connected to a surgical opening created in the abdomen (stoma) and feces is then passed through the stoma into a sealed pouch outside the body. Colostomies are often performed on babies born without an anal opening or those with an abnormal opening, as they await their full reconstructive surgery. The procedure is reversible.
What to expect after surgery?
Your child will stay in the hospital for a few days after surgery. IV fluids will be given, and pain medication, if necessary. Our team will teach you how to care for your child’s colostomy at home. The stoma will be deep red or pink and moist — that is normal. The skin around the stoma opening can become irritated. We will teach you which creams you can apply to protect your child’s skin and how to properly care for your child’s stoma.
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When you set up your child’s first visit, we will work with you to obtain copies of any previous surgeries or diagnostic studies your child has had. Providing this information before your first appointment will allow our team to make the most of your first visit. To help us get to know your child better and establish goals for your visit, we will ask you to complete an intake form.
On the day of the clinic visit, you and your child will meet the members of each specialty team separately to talk about your child’s condition. We will then return to your exam room together to examine your child and discuss a comprehensive treatment plan before you leave. Sometimes, we will have you get a x-ray or an ultrasound the morning before your appointment. We will let you know ahead of time if your child needs to have a radiology appointment and will help you schedule it.
When your child needs surgery, it can be a stressful and emotional event for not only the patient, but for the whole family. It helps to know what to expect before, during and after surgery so you, your child and your family feel more prepared.
The surgery teams at Texas Children’s work to make your child’s surgery experience safe and as comfortable as possible. Below are videos and guides and a timeline to help you and your family learn what to expect when having surgery at Texas Children’s.
