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bowel management program

The multidisciplinary bowel management program at Dayton Children's Hospital is for children who have refractory constipation or encopresis.

Refractory constipation is when a child is not able to poop regularly even after completing clean outs and taking laxatives (medication to help a person poop).

Encopresis is when a child leaks poop accidentally. These accidents usually happen due to the buildup of poop that is more difficult to pass with looser poop leaking around it. As the buildup of poop stretches the colon, the nerves have trouble telling the brain it's time to poop. Accidents can be very embarrassing for your child, leading to denial and hiding soiled underpants.

If your child is referred to the bowel management program, they will see multiple health care providers in a single location to address all aspects of care for refractory constipation and encopresis.

Learn more about constipation and encopresis.

who can benefit from the bowel management program?

  • Children greater than 4 years of age
  • Has constipation and encopresis for greater than 6 months
  • Failed conservative management
    • Completed more than two home bowel clean outs AND continuing maintenance bowel regimen following clean out without improvement in symptoms.
    • Completed more than one inpatient clean out AND continuing maintenance bowel regimen following without improvement in symptoms.
  • No additional contributing GI specific health issues (for example spinal cord abnormalities, anorectal malformations or Hirschsprung disease).

how long does the bowel management program last?

The program lasts 12 months including an initial visit with a care team and follow up visits to include:

  1. A video visit follow up at 6 weeks
  2. A multidisciplinary visit in office at 3, 6, 9 and 12 months

Families should plan 1.5 to 2 hours for each of these visits (except for the virtual follow up at 6 weeks).

what testing may be considered while in the program?

  • Screening labs (consideration of underlying medical conditions, if not already done)
  • Abdominal X-rays (picture of abdomen to evaluate stool burden)
  • Water soluble contrast enema (enema given by radiology staff filled with water soluble contrast material which enters the colon and highlights the anatomy of the colon)
  • Anorectal manometry testing (assessment of pressure and sensations in the rectum)

what are management options considered while in the program?

Your child may need to do home bowel clean outs and maintenance laxative regimens using rectal therapy (suppository or enema), stool softeners and stimulant laxatives.

Your child may need additional or ongoing visits with physical therapy for pelvic floor training and/or with psychology for behavioral health management.

We will provide necessary school resources (i.e., 504 plan information, notes for bathroom privileges, etc).

Certain dietary modifications may be recommended.

what will my child's care team look like?

Your child will be seen by a physician assistant (medical provider), psychologist, social worker, dietitian, physical therapist and a nurse.









Jessica Alexander, MPAS, PA-C, CAQ-Peds

  • Nationally certified physician assistant 

  • Over ten years of experience, spending the last six years in the division of gastroenterology at Dayton Children's.

  • Special interest in helping children with constipation and encopresis.

  • Worked as a physician assistant in family practice as an active-duty member of the United States Air Force.

  • Enjoys baking and spending time with her family going to parks and sporting events.










Cheryl Alvarez, RN

  • Pediatric registered nurse 

  • Has worked at Dayton Children's since 1997 in several departments before landing in gastroenterology.

  • Wants patients dealing with constipation and encopresis to know they are not alone and their diagnosis is much more common than they realize.

  • Enjoys spending time with her family, watching her son's sporting events and starting new craft projects.










Rachel Baughman, RN, BSN, CPN 

  • Pediatric registered nurse

  • Previously worked on the inpatient unit at Dayton Children's for respiratory and gastroenterology patients.

  • Enjoys spending time with her family, traveling and being outdoors.










Caitlyn Davidson, MSW, LISW

  • Senior medical social worker in gastroenterology and nutrition

  • Grateful to have the opportunity to partner with families, provide compassionate support, fierce advocacy, empowerment and multidisciplinary work each day.

  • Enjoys keeping up with her kids, catching a game with her husband or relaxing with her nose in a book.










Sarah Kolaczynski, MSW, LSW

  • Senior medical social worker in gastroenterology and nutrition

  • Strives to advocate for patients and families and is thankful for the opportunity to work alongside families during their most difficult moments.

  • Enjoys traveling to new places, learning and experiencing new cultures and foods, exploring the outdoors and spending time with her cat.










Sarah Lyons, RDN, LD

  • Clinical dietitian in gastroenterology and nutrition

  • Specializes in enternal nutrition management, inflammatory bowel disease, malnutrition, constipation and infant/toddler nutrition.

  • Enjoys quality time with family, cooking for friends and exploring the great outdoors.










Jessica McCarthy, PsyD

  • Pediatric psychologist

  • Specializes in working with children, adolescents and their families who have chronic medical conditions, chronic pain, and functional and somatic symptoms disorders.

  • Currently integrated into gastroenterology, providing behavioral health management in children and adolescents with inflammatory bowel disease, constipation/encopresis, and disorders of the gut-brain interaction (DGBI's).

  • Enjoys spending time with her family, reading and traveling.










Brittany Zoll, PT, DPT

  • Pediatric physical therapist

  • Has a special interest in working with children with gross motor delays, torticollis, cerebral palsy, genetic disorders, and issues involving the bowel and bladder.

  • Enjoys spending time with her husband and two children. She loves reading, exploring different parks, family game nights and spending time with her large extended family.