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The term bowel management refers to an individualized program for fecal incontinent patients. The main principle is the administration of fluid to wash out the colon, either transanally or antegrade through a stoma.A literature search was performed to find the best method to keep fecal incontinent children clean.Bowel management with an individually determined amount of fluid, either by abdominal radiographs or hydrosonography, showed better success rates compared with transanal enemas with an estimated amount of fluid. Furthermore, transanal enemas had higher success rates compared with bowel management with antegrade continence enemas and showed fewer complications.To improve a child’s quality of life an antegrade continence enema can be considered. Before surgery it has to be shown that a bowel management with rectal irrigations works. The indication for a surgical approach for bowel management has to be set carefully. Conservative measures must be tried first.