Sometimes it’s necessary to completely clean out the bowel from top to bottom. This is a process similar to prepping for a colonoscopy.

Why do a Clean Out?

Before starting a bowel program like cone enemas, having a clean colon can make the program much more effective than trying to deal with constipation instead of just daily maintenance. Even when on a bowel program, sometimes constipation creeps up and the situation is dire enough to need a strong clean out to start fresh. Before bowel surgeries such as the MACE, most doctors require a full clean out in the hospital. But some families choose home clean outs before other surgeries, such as detetherings, because we know there’s a high risk of constipation due to anesthesia, pain medications, lying in a hospital bed, and inability to do enemas while on bed rest.

How to do a Clean Out

Miralax Clean Out: If there’s no previous bowel program in place, one of the quickest and most effective clean out techniques consists of using 3-6 capfuls of Miralax per day for two-three days or as needed. (For children under 4, perhaps use half capfuls.) That sometimes sounds shocking to parents, and you should absolutely check with your child’s doctor and do what you feel comfortable with. You can certainly slow it down, just be prepared that it will take longer, which can sometimes result in diaper rash and skin breakdown. Most people prefer to “hit it hard and heavy” and get it over with. Lots and lots of fluids are needed to be successful. The clean out will usually be complete on day 3.

It will be messy. Do it when you can stay home for a few days. Expect to see a “pooplosion.” (You’ll know it when you see it.) Consider covering one seat on your couch with a trash bag and a towel and insist that is the seat of honor for the pooper. You’ll know you’ve achieved clean out status when the stool is the color and consistency of tea: light brown liquid. To make the clean out go more quickly and easily, some people add senna or phosphate enemas each day to help flush out all that soft stool.

Enema/MACE Clean Out: When someone is already on a regular enema or MACE flush program, there are easier ways to do a clean out than with just Miralax. Many people do two enemas per day for two days. Some will add a capful of Miralax to their solution for the morning enema and a phosphate enema to the night enema.

Hospital Clean Out: Before a MACE or other bowel procedure, many surgeons insist on achieving a squeaky clean colon by admitting the person for a full bowel clean out in the hospital. This usually consists of ingesting Golytely orally or through a feeding tube.

Besides prior to bowel surgeries, we try to avoid hospital clean outs by taking appropriate measures at home. Hospital clean outs are at best unpleasant and at worst traumatic, and emergency department docs are usually not well versed in neurogenic bowel. If after trying everything possible at home with no results, or if you suspect an impaction, head to the ER for a Golytely clean out.

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