Monica Holder

87 statements · 3 topics

Colorectal / ARM & Hirschsprung · guest expert

Featured statements

▶ Ep 2 · 43:14
Female anorectal malformation patients should see a gynecologist for reproductive health evaluation and examination.
guideline · Anorectal Malformation
▶ Ep 2 · 54:22
Some children are evaluated and can potty train with oral regimen; others without good continence potential start on enemas immediately. Some on enemas for years can later come off enemas and potty train when they have more maturity and buy-in, depending on anatomy.
clinical · Anorectal Malformation
▶ Ep 2 · 53:33
Bowel management program starts when parent feels child needs to be in normal underwear (typically preschool/kindergarten age when peers are in underwear), not at a hard age cutoff; this can be age 3, 4, or later if child is home and not socially engaged yet.
clinical · Colorectal / ARM & Hirschsprung
▶ Ep 2 · 23:02
Many patients referred for bowel resection have tried enemas/laxatives at doses based on age, weight, or manufacturer recommendations, but severe constipation often requires much higher doses than outlined; additional treatment may still achieve success.
clinical · Colorectal / ARM & Hirschsprung
▶ Ep 1 · 29:19
When colonic manometry proves lower bowel has poor contraction, colostomy on upper colon allows lower colon to rest; after 6 months to 1 year (sometimes 2 years), repeat manometry checks if bowel has recovered motility, then colostomy can be closed.
clinical · Hirschsprung disease
▶ Ep 1 · 15:27
Patients with almost all large bowel removed may achieve cleanliness on enemas but require very regimented diet (avoiding laxative foods, high-sugar drinks) and multiple daily Imodium doses; some choose stoma over this quality-of-life burden.
clinical · Hirschsprung disease

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Monica's statements about Anorectal Malformation 29 statements

Open the Anorectal Malformation collection →

Bowel Management Updates & Innovations with Live Q&A: April 2018

▶ Ep 2 · 9:11
clinical To reduce enema-related nausea, give enema prior to meals or about an hour after a meal to allow digestion, avoiding administration right after a full meal when stomach distention plus bowel filling causes nausea. ↗
▶ Ep 2 · 9:32
clinical In cecostomy patients, if enema solution flows too fast or goes into small bowel instead of colon, it can cause vomiting; a study can track solution flow to diagnose this. ↗
▶ Ep 2 · 9:56
clinical Warming enema solution and ensuring irritant is not too strong for the child helps reduce vomiting; additive and volume must be adjusted to treat symptoms. ↗
▶ Ep 2 · 10:18
clinical Enema solution should be given over at least 5 minutes, sometimes 10–15 minutes, to avoid rapid distention and vomiting. ↗
▶ Ep 2 · 12:41
clinical Maximum enema volume is tailored to colon size based on contrast enema study; typically upper limit is around 500 mL for rectal and cecostomy/Malone enemas, occasionally slightly higher but rarely. ↗
▶ Ep 2 · 15:27
clinical Patients with almost all large bowel removed may achieve cleanliness on enemas but require very regimented diet (avoiding laxative foods, high-sugar drinks) and multiple daily Imodium doses; some choose stoma over this quality-of-life burden. ↗
▶ Ep 2 · 23:02
clinical Many patients referred for bowel resection have tried enemas/laxatives at doses based on age, weight, or manufacturer recommendations, but severe constipation often requires much higher doses than outlined; additional treatment may still achieve success. ↗
▶ Ep 2 · 24:02
clinical There is no research showing scary outcomes from long-term Senna (Ex-Lax) use; patients may need dose increases or decreases over time based on diet, exercise, and hormonal changes. ↗
▶ Ep 2 · 24:45
clinical Long-term Senna use causes melanosis coli (freckling appearance on colonoscopy) but no other long-term side effects beyond this visual finding. ↗
▶ Ep 2 · 26:16
clinical Excessive laxative dose causes diarrhea; laxative use must be adjusted and monitored by healthcare provider. ↗
▶ Ep 2 · 28:52
clinical Patients with colostomy can still suffer from constipation and may require stool softener or laxative for daily colostomy output. ↗
▶ Ep 2 · 29:19
clinical When colonic manometry proves lower bowel has poor contraction, colostomy on upper colon allows lower colon to rest; after 6 months to 1 year (sometimes 2 years), repeat manometry checks if bowel has recovered motility, then colostomy can be closed. ↗
▶ Ep 2 · 31:16
clinical Cone enemas are not routinely used in the Cincinnati program, but if patients are already using them successfully, the team will adjust enema ingredients within that delivery system. ↗
▶ Ep 2 · 32:11
clinical Enema-related pain requires evaluation for injury from enema device (fissures, cuts, ulcers in anal region) and also consideration of other abdominal organ causes (appendix, gallbladder) to avoid missing non-constipation diagnoses. ↗
▶ Ep 2 · 33:27
clinical Peristeen device was originally designed for spina bifida patients, with features for those with limited finger dexterity or arm use; requires physician order and education for independent use. ↗
▶ Ep 2 · 34:08
clinical Peristeen has better success in patients age 8 or older; younger patients (under 8) had difficulty keeping the balloon device in the rectum. ↗
▶ Ep 2 · 34:33
clinical Peristeen insurance coverage is challenging; insurance companies typically deny initially because product is not widely used in US, requiring appeal letters and significant paperwork from healthcare provider. ↗
▶ Ep 2 · 39:22
clinical Urinary symptom improvement with sacral nerve stimulator often exceeds the manufacturer's 50% improvement threshold. ↗
▶ Ep 2 · 40:05
clinical Sacral nerve stimulator has approximately 4 different programs; if symptoms return over time, the program can be changed within the implant to regain success. ↗
▶ Ep 2 · 41:31
clinical New bedtime wetting in a patient previously clean on bowel management is suspected to be constipation; this is checked first before other evaluation. ↗
▶ Ep 2 · 43:14
guideline Female anorectal malformation patients should see a gynecologist for reproductive health evaluation and examination. ↗
▶ Ep 2 · 45:32
clinical Any enema irritant (glycerin, castile soap) must be monitored; if patient produces mucus when stooling, consider if bowel is over-irritated and dial back additives or change product. ↗
▶ Ep 2 · 46:55
clinical Fleet phosphate enema must be avoided in patients with any renal injury or kidney trouble. ↗
▶ Ep 2 · 50:49
clinical Patients with deformed sacrum have a range of anatomy; some still have continence potential despite sacral deformity on paper. ↗
▶ Ep 2 · 51:15
clinical For very deformed sacrum not suitable for sacral nerve stimulator, best option is enema (rectal, Malone, cecostomy, or Peristeen). ↗
▶ Ep 2 · 52:52
clinical Children with normal anatomy typically potty train between 2.5 to 3.5 years, sometimes even 4 years; this varies by culture and location. Boys tend to potty train later than girls. ↗
▶ Ep 2 · 53:33
clinical Bowel management program starts when parent feels child needs to be in normal underwear (typically preschool/kindergarten age when peers are in underwear), not at a hard age cutoff; this can be age 3, 4, or later if child is home and not socially engaged yet. ↗
▶ Ep 2 · 54:22
clinical Some children are evaluated and can potty train with oral regimen; others without good continence potential start on enemas immediately. Some on enemas for years can later come off enemas and potty train when they have more maturity and buy-in, depending on anatomy. ↗
▶ Ep 2 · 56:14
clinical Patients with right anatomy for potty training may fail due to inadequate treatment; severe constipation causes stool leaking around impaction without sensation, so adequate treatment allows normal potty training. ↗
Monica's statements about Colorectal / ARM & Hirschsprung 29 statements

Open the Colorectal / ARM & Hirschsprung collection →

Bowel Management Updates & Innovations with Live Q&A: April 2018

▶ Ep 2 · 9:11
clinical To reduce enema-related nausea, give enema prior to meals or about an hour after a meal to allow digestion, avoiding administration right after a full meal when stomach distention plus bowel filling causes nausea. ↗
▶ Ep 2 · 9:32
clinical In cecostomy patients, if enema solution flows too fast or goes into small bowel instead of colon, it can cause vomiting; a study can track solution flow to diagnose this. ↗
▶ Ep 2 · 9:56
clinical Warming enema solution and ensuring irritant is not too strong for the child helps reduce vomiting; additive and volume must be adjusted to treat symptoms. ↗
▶ Ep 2 · 10:18
clinical Enema solution should be given over at least 5 minutes, sometimes 10–15 minutes, to avoid rapid distention and vomiting. ↗
▶ Ep 2 · 12:41
clinical Maximum enema volume is tailored to colon size based on contrast enema study; typically upper limit is around 500 mL for rectal and cecostomy/Malone enemas, occasionally slightly higher but rarely. ↗
▶ Ep 2 · 15:27
clinical Patients with almost all large bowel removed may achieve cleanliness on enemas but require very regimented diet (avoiding laxative foods, high-sugar drinks) and multiple daily Imodium doses; some choose stoma over this quality-of-life burden. ↗
▶ Ep 2 · 23:02
clinical Many patients referred for bowel resection have tried enemas/laxatives at doses based on age, weight, or manufacturer recommendations, but severe constipation often requires much higher doses than outlined; additional treatment may still achieve success. ↗
▶ Ep 2 · 24:02
clinical There is no research showing scary outcomes from long-term Senna (Ex-Lax) use; patients may need dose increases or decreases over time based on diet, exercise, and hormonal changes. ↗
▶ Ep 2 · 24:45
clinical Long-term Senna use causes melanosis coli (freckling appearance on colonoscopy) but no other long-term side effects beyond this visual finding. ↗
▶ Ep 2 · 26:16
clinical Excessive laxative dose causes diarrhea; laxative use must be adjusted and monitored by healthcare provider. ↗
▶ Ep 2 · 28:52
clinical Patients with colostomy can still suffer from constipation and may require stool softener or laxative for daily colostomy output. ↗
▶ Ep 2 · 29:19
clinical When colonic manometry proves lower bowel has poor contraction, colostomy on upper colon allows lower colon to rest; after 6 months to 1 year (sometimes 2 years), repeat manometry checks if bowel has recovered motility, then colostomy can be closed. ↗
▶ Ep 2 · 31:16
clinical Cone enemas are not routinely used in the Cincinnati program, but if patients are already using them successfully, the team will adjust enema ingredients within that delivery system. ↗
▶ Ep 2 · 32:11
clinical Enema-related pain requires evaluation for injury from enema device (fissures, cuts, ulcers in anal region) and also consideration of other abdominal organ causes (appendix, gallbladder) to avoid missing non-constipation diagnoses. ↗
▶ Ep 2 · 33:27
clinical Peristeen device was originally designed for spina bifida patients, with features for those with limited finger dexterity or arm use; requires physician order and education for independent use. ↗
▶ Ep 2 · 34:08
clinical Peristeen has better success in patients age 8 or older; younger patients (under 8) had difficulty keeping the balloon device in the rectum. ↗
▶ Ep 2 · 34:33
clinical Peristeen insurance coverage is challenging; insurance companies typically deny initially because product is not widely used in US, requiring appeal letters and significant paperwork from healthcare provider. ↗
▶ Ep 2 · 39:22
clinical Urinary symptom improvement with sacral nerve stimulator often exceeds the manufacturer's 50% improvement threshold. ↗
▶ Ep 2 · 40:05
clinical Sacral nerve stimulator has approximately 4 different programs; if symptoms return over time, the program can be changed within the implant to regain success. ↗
▶ Ep 2 · 41:31
clinical New bedtime wetting in a patient previously clean on bowel management is suspected to be constipation; this is checked first before other evaluation. ↗
▶ Ep 2 · 43:14
guideline Female anorectal malformation patients should see a gynecologist for reproductive health evaluation and examination. ↗
▶ Ep 2 · 45:32
clinical Any enema irritant (glycerin, castile soap) must be monitored; if patient produces mucus when stooling, consider if bowel is over-irritated and dial back additives or change product. ↗
▶ Ep 2 · 46:55
clinical Fleet phosphate enema must be avoided in patients with any renal injury or kidney trouble. ↗
▶ Ep 2 · 50:49
clinical Patients with deformed sacrum have a range of anatomy; some still have continence potential despite sacral deformity on paper. ↗
▶ Ep 2 · 51:15
clinical For very deformed sacrum not suitable for sacral nerve stimulator, best option is enema (rectal, Malone, cecostomy, or Peristeen). ↗
▶ Ep 2 · 52:52
clinical Children with normal anatomy typically potty train between 2.5 to 3.5 years, sometimes even 4 years; this varies by culture and location. Boys tend to potty train later than girls. ↗
▶ Ep 2 · 53:33
clinical Bowel management program starts when parent feels child needs to be in normal underwear (typically preschool/kindergarten age when peers are in underwear), not at a hard age cutoff; this can be age 3, 4, or later if child is home and not socially engaged yet. ↗
▶ Ep 2 · 54:22
clinical Some children are evaluated and can potty train with oral regimen; others without good continence potential start on enemas immediately. Some on enemas for years can later come off enemas and potty train when they have more maturity and buy-in, depending on anatomy. ↗
▶ Ep 2 · 56:14
clinical Patients with right anatomy for potty training may fail due to inadequate treatment; severe constipation causes stool leaking around impaction without sensation, so adequate treatment allows normal potty training. ↗
Monica's statements about Hirschsprung disease 29 statements

Open the Hirschsprung disease collection →

Bowel Management Updates & Innovations with Live Q&A: April 2018

▶ Ep 1 · 9:11
clinical To reduce enema-related nausea, give enema prior to meals or about an hour after a meal to allow digestion, avoiding administration right after a full meal when stomach distention plus bowel filling causes nausea. ↗
▶ Ep 1 · 9:32
clinical In cecostomy patients, if enema solution flows too fast or goes into small bowel instead of colon, it can cause vomiting; a study can track solution flow to diagnose this. ↗
▶ Ep 1 · 9:56
clinical Warming enema solution and ensuring irritant is not too strong for the child helps reduce vomiting; additive and volume must be adjusted to treat symptoms. ↗
▶ Ep 1 · 10:18
clinical Enema solution should be given over at least 5 minutes, sometimes 10–15 minutes, to avoid rapid distention and vomiting. ↗
▶ Ep 1 · 12:41
clinical Maximum enema volume is tailored to colon size based on contrast enema study; typically upper limit is around 500 mL for rectal and cecostomy/Malone enemas, occasionally slightly higher but rarely. ↗
▶ Ep 1 · 15:27
clinical Patients with almost all large bowel removed may achieve cleanliness on enemas but require very regimented diet (avoiding laxative foods, high-sugar drinks) and multiple daily Imodium doses; some choose stoma over this quality-of-life burden. ↗
▶ Ep 1 · 23:02
clinical Many patients referred for bowel resection have tried enemas/laxatives at doses based on age, weight, or manufacturer recommendations, but severe constipation often requires much higher doses than outlined; additional treatment may still achieve success. ↗
▶ Ep 1 · 24:02
clinical There is no research showing scary outcomes from long-term Senna (Ex-Lax) use; patients may need dose increases or decreases over time based on diet, exercise, and hormonal changes. ↗
▶ Ep 1 · 24:45
clinical Long-term Senna use causes melanosis coli (freckling appearance on colonoscopy) but no other long-term side effects beyond this visual finding. ↗
▶ Ep 1 · 26:16
clinical Excessive laxative dose causes diarrhea; laxative use must be adjusted and monitored by healthcare provider. ↗
▶ Ep 1 · 28:52
clinical Patients with colostomy can still suffer from constipation and may require stool softener or laxative for daily colostomy output. ↗
▶ Ep 1 · 29:19
clinical When colonic manometry proves lower bowel has poor contraction, colostomy on upper colon allows lower colon to rest; after 6 months to 1 year (sometimes 2 years), repeat manometry checks if bowel has recovered motility, then colostomy can be closed. ↗
▶ Ep 1 · 31:16
clinical Cone enemas are not routinely used in the Cincinnati program, but if patients are already using them successfully, the team will adjust enema ingredients within that delivery system. ↗
▶ Ep 1 · 32:11
clinical Enema-related pain requires evaluation for injury from enema device (fissures, cuts, ulcers in anal region) and also consideration of other abdominal organ causes (appendix, gallbladder) to avoid missing non-constipation diagnoses. ↗
▶ Ep 1 · 33:27
clinical Peristeen device was originally designed for spina bifida patients, with features for those with limited finger dexterity or arm use; requires physician order and education for independent use. ↗
▶ Ep 1 · 34:08
clinical Peristeen has better success in patients age 8 or older; younger patients (under 8) had difficulty keeping the balloon device in the rectum. ↗
▶ Ep 1 · 34:33
clinical Peristeen insurance coverage is challenging; insurance companies typically deny initially because product is not widely used in US, requiring appeal letters and significant paperwork from healthcare provider. ↗
▶ Ep 1 · 39:22
clinical Urinary symptom improvement with sacral nerve stimulator often exceeds the manufacturer's 50% improvement threshold. ↗
▶ Ep 1 · 40:05
clinical Sacral nerve stimulator has approximately 4 different programs; if symptoms return over time, the program can be changed within the implant to regain success. ↗
▶ Ep 1 · 41:31
clinical New bedtime wetting in a patient previously clean on bowel management is suspected to be constipation; this is checked first before other evaluation. ↗
▶ Ep 1 · 43:14
guideline Female anorectal malformation patients should see a gynecologist for reproductive health evaluation and examination. ↗
▶ Ep 1 · 45:32
clinical Any enema irritant (glycerin, castile soap) must be monitored; if patient produces mucus when stooling, consider if bowel is over-irritated and dial back additives or change product. ↗
▶ Ep 1 · 46:55
clinical Fleet phosphate enema must be avoided in patients with any renal injury or kidney trouble. ↗
▶ Ep 1 · 50:49
clinical Patients with deformed sacrum have a range of anatomy; some still have continence potential despite sacral deformity on paper. ↗
▶ Ep 1 · 51:15
clinical For very deformed sacrum not suitable for sacral nerve stimulator, best option is enema (rectal, Malone, cecostomy, or Peristeen). ↗
▶ Ep 1 · 52:52
clinical Children with normal anatomy typically potty train between 2.5 to 3.5 years, sometimes even 4 years; this varies by culture and location. Boys tend to potty train later than girls. ↗
▶ Ep 1 · 53:33
clinical Bowel management program starts when parent feels child needs to be in normal underwear (typically preschool/kindergarten age when peers are in underwear), not at a hard age cutoff; this can be age 3, 4, or later if child is home and not socially engaged yet. ↗
▶ Ep 1 · 54:22
clinical Some children are evaluated and can potty train with oral regimen; others without good continence potential start on enemas immediately. Some on enemas for years can later come off enemas and potty train when they have more maturity and buy-in, depending on anatomy. ↗
▶ Ep 1 · 56:14
clinical Patients with right anatomy for potty training may fail due to inadequate treatment; severe constipation causes stool leaking around impaction without sensation, so adequate treatment allows normal potty training. ↗