Garrett is Doing Well After Successful Treatment Via Colorectal Center’s Bowel Management Program

One phone conversation. That’s all it took for Sarah Publiski to know in her heart that Cincinnati Children’s was the right place for her son, Garrett.

As the nurse listened patiently, Sarah provided a detailed medical history and timeline, explaining that her son was entering the second grade and still dealing with chronic bowel problems. For more than four years, he had battled constipation, uncontrollable soiling (encopresis), and urinary and fecal incontinence.

Finding Hope at Cincinnati Children’s

With little progress being made under the care of local doctors in Michigan, Sarah wanted clearer answers and a better solution for her son, so she began online research in August 2020. She quickly learned about the Cincinnati Children’s Colorectal Center and wondered how things might improve for Garrett if he was a patient there. 

She was hopeful. During those early weeks of research, her first phone call with Cincinnati Children’s confirmed she had reason to hope. After hearing Garrett’s background story, the nurse replied, “I think we can help you.”

Words that Sarah and her husband, Cole, had longed to hear.

“To hear those words, it was just amazing to know that someone was finally going to help,” Sarah said. 

An appointment was set with the Bowel Management Program team to discuss next steps. In December, they traveled south and spent a week at Cincinnati Children’s. Not only did they meet with Nelson Rosen, MD, associate director of the Colorectal Center, they also met and spoke with a psychologist and physical therapist. 

“I was beyond impressed with Cincinnati Children's. It was amazing how coordinated everybody was,” Sarah said. “Every step of the way has been incredible. The Bowel Management Program and the physical therapy—those are the two biggest things that helped Garrett.” 

Becoming Accident-Free

Since he started the program three years ago, which also includes a regular enema regimen, Garrett has not had a single fecal incident. 

Occasionally, urinary incontinence issues arise but Garrett is improving every day as his core muscle strength increases, thanks in part to physical therapy and occupational therapy. As part of pelvic health therapy, Garrett and other colorectal patients learn how to tighten and relax their pelvic muscles through exercises that can support success in emptying or controlling the muscles around the bowel and bladder. 

According to Dr. Rosen, another significant reason for Garrett’s continued success—and patients like him—involves the frequency and effectiveness of high-volume rectal enemas. 

“High volume rectal enemas work very effectively because the patient controls when they're given,” Dr. Rosen explained. “The common issue with our patients is that they have emptying issues—some don't empty completely and the stool that stays behind causes accidents. Others don't sense when they have to empty and that leads to accidents.”  

Laxatives are another option to stimulate emptying, but those medications affect people at random times, when patients may not be able to get to a bathroom before an accident occurs.

“Enemas are much more controlled,” Dr. Rosen said. “By giving the enema when they want to, they can get rid of a full day's worth of stool production. The enema works right away. This leaves them completely clean.”

For Garrett, the number of required enemas has decreased from seven a week during the summer to currently five a week, which the family will maintain throughout the school year. 

Rebuilding Garrett’s Confidence

Now in the fifth grade, Garrett, 11, is doing very well in school and for fun he enjoys spending time outdoors with his older brother, Ethan, 14, going camping in the woods and fishing.

“It’s heartbreaking to see your kid go through what he’s been through,” Sarah said. “He never complains, but I can’t imagine what it did to his self-esteem. As time goes on, and the farther we get from those days [before the Bowel Management Program], I think his confidence is definitely building.” 

She also knows that many people don’t like to talk about fecal incontinence because they consider it “embarrassing” or “gross.” But Sarah takes the opposite approach. 

“I talk about it all the time, because if it can help one family not go through what Garrett has gone through, then it’s completely worth it. It’s important for people to know.” 

Dr. Rosen agrees. “I just wish more people knew about bowel management programs and that more regions offered the service. We provide it because we are complex anorectal and urogenital reconstructive surgeons, and many of our patients need it. Patients like Garrett benefit from that expertise as well as the infrastructure we built to support it.”

According to Dr. Rosen, a bowel management program can be created almost anywhere, and doesn't require extensive resources.

“A pediatrician, gastroenterologist or nurse practitioner could learn to run the program,” he said. “It’s just not a thing that many people think about, and it's certainly not something taught in medical school or nursing school. We have to spread the word.”

(Published December 2023)