Getting Ready for Colorectal Surgery

Your child’s bowel needs to be clear of stool for the procedure. This is to ensure their safety and to reduce the risk of infection. The only way to make sure the bowel is clear of stool for the procedure is to begin this bowel prep at home. If your child’s bowel is not completely clear before surgery the procedure will be cancelled.

• A medicine called Miralax® will be given to make the stool loose and bowel movements more frequent. Expect your child to need frequent diaper changes or trips to the toilet.
• The time needed for the bowel prep to be complete will depend on your child’s history. On average, expect the bowel prep to last 8 to 12 hours. Some children may need two days to clear the bowel (this will be reflected on your itinerary).
• Please follow the dosing below based on your child’s age:
  
  • Less than 5 years old: Mix 4 capfuls (68 grams) of Miralax® in 16 ounces of sports drink such as Gatorade® or Pedialyte®
  • 6 years to 11 years old: Mix 7 capfuls ( 119 grams) of Miralax® in 32 ounces of sports drink such as Gatorade® or Pedialyte®
  • 12 years or older: Mix 14 capfuls ( 238 grams) of Miralax® in 64 ounces of sports drink such as Gatorade® or Pedialyte®
• Continue the bowel preparation at home until you receive a call from the hospital saying a bed is ready.

Change to clear liquid only. A clear liquid diet includes foods that are liquid at room temperature that you can see through or read a newspaper through. Examples of clear liquids are Pedialyte®, clear broth, Gatorade® or Powerade®, clear fruit juice, ices, sorbet, Jell-O®, etc.

During your child’s hospital stay, we will check temperature, blood pressure, heart rate, respiratory rate and oxygen levels every four hours.

Your child will need to keep hydrated with intravenous (IV) fluids since there will be restrictions on eating and drinking before and after surgery. This means an IV will be placed in your child. An IV is a small tube (catheter) that is placed in a vein. The IV will stay until your child goes home from the hospital.

Many parents report this is the hardest part of the hospital stay. Your child’s bowel will need to be clear of stool for the procedure to keep them safe and to reduce the risk of infection. To make sure the bowel gets clean, the bowel prep will need to be finished the night before their surgery or procedure.

Your child will likely be given the bowel prep medicine through a nasogastric (NG) tube. An NG tube is put in through the nose and goes down into your child’s stomach. The tube is taped to the cheek to make sure it does not fall out. The medicine is then given through the tube over a pump throughout the evening until the medical team determines it safe to stop.

If your child has a Malone or cecostomy tube, they may be able to receive the medicine through that tube.

Rest assured that this bowel prep is absolutely necessary to keep your child safe and assist with a successful surgical procedure.Our inpatient nursing team will take good care of you during your hospital stay!

Your child may need rectal irrigations during the bowel prep. Learn more about the rectal irrigation process.

• A rectal irrigation is done by putting a tube in your child’s rectum and flushing saline through the tube to help empty the stool and gas from the bowels.
• Your child may need rectal irrigations every one to two hours during the bowel prep.

A Malone appendicostomy is a surgery that creates a channel from the belly button to the right side of the colon using the appendix. This channel has a one-way valve that will allow a catheter to go in, but no fluids or leakage to come out. By using your child's own appendix we can avoid the use of artificial devices which can be seen and can cause irritation. Learn more about the malone appendicostomy process.

If you have any questions or concerns, call the colorectal team at 202-476-COLO (2656) between 8 a.m. - 4:30 p.m. After 4:30 p.m., call 202-476-5000 and ask for the surgical resident on-call. You can also email the nursing team.