Among the problems that we have seen is that patients become accustomed to the smell of stool, and do not perceive that their odor upsets the entire family and anyone around them. We have seen terrible psychological problems derived from the fact that parents refuse to provide bowel management with the hope that the child becomes toilet trained and in the meantime, the child goes several years dirty, smelly and segregated. Again, however, we always respect the patient's decision. I truly believe that this is a quality of life issue. Yes, there is a higher chance of a child becoming toilet trained as time goes by.
Some patients have a borderline type of bowel control.
In other words, they have a minimal sensation to perceive when the stool is moving in their rectum. If they are very young and they are busy playing, they do not pay attention to that minimal sensation. As the child grows, he becomes more interested in his own bowel function and he may concentrate on perceiving that weak sensation which could be the difference between bowel control and no bowel control. In our experience, the decision to have a permanent colostomy is usually taken by an adolescent patient who is tired of being subjected to bowel management. He is now ready to go to college and feels that having a stoma is a better choice than doing bowel management.