Postoperative Care Instructions for Antegrade Colonic Enema (ACE) Procedures

The instructions below are general guidelines. Specific changes or instructions for each patient may differ. Please follow instructions provided by the surgeon and CHOC Urology staff.

Thank you for choosing CHOC for surgery. Antegrade Colonic Enema (ACE) creation procedures are performed in an operating room in the CHOC Surgery Center. The procedure is completed on an inpatient basis and requires a two- to five-day stay in the hospital after surgery. This surgery is also known as the Malone Antegrade Colonic Enema (MACE).


Patients only consume clear liquids immediately after surgery and then progress to a regular diet as tolerated. The anesthesia can cause stomach discomfort and nausea.

Pain management

Patients will be managed for pain while in the hospital. Patients may be sent home with Tylenol #3 to be taken as needed for pain. If the doctor prescribed Tylenol #3 (with codeine) tablet or elixir, only give the patient as little as possible because codeine can cause constipation, which can be painful. Miralax is an over the counter stool softener and can be used to relieve constipation if it occurs. Whenever possible, try to use Ibuprofen (also known as Motrin or Advil) instead of the Tylenol #3. Do not take Tylenol #3 and Tylenol at the same time, as this can be an overdose and is harmful. If needed, Ibuprofen and ONE Tylenol product can be taken within the same time period. Please contact our office with any questions regarding dosage and timing of pain medication.

Incision care

The child’s postoperative care will take place while in the hospital by the CHOC medical staff. Patients are sent home with a catheter in the ACE, which will stay in place for about one week. This will allow the ACE time to heal properly. Patients are seen at the CHOC Urology Center about one week after discharge from the hospital in order to have one of our medical providers remove the catheter and teach you and/or your child how to properly catheterize and irrigate the ACE.

Activity restrictions

For two to three weeks after the surgery, the child should avoid trauma to the surgical area and avoid rough housing, contact sports, bicycle riding or physical education. Further activity restrictions will be provided upon the child’s discharge from the hospital.

For more information on how to prepare children of all ages for surgery and what to expect the day of surgery, please read our comprehensive surgery guide.