Malone Antegrade Continence Enema (MACE) Program

The Malone Antegrade Continence Enema (MACE) Program at Riley at IU Health provides a treatment to restore normal bowel function. This treatment helps your child return to school and regular activities and enjoy eating again. The MACE Program at Riley at IU Health is the only one of its kind in Indiana. We provide care to children from across Indiana, as well as from many other states.

Board certified pediatric gastroenterologists and surgeons lead the MACE program, which offers a surgical way to clean out the colon. Before your child is approved for the MACE procedure, doctors will perform a full medical workup to rule out any underlying conditions. A physical examination may be combined with: 

• Motility tests. These tests are performed to study the function of the intestines and rectum. Types of motility tests include:
  • Antroduodenal manometry
  • Colonic motility study 
  • Anorectal manometry
• Magnetic resonance imaging (MRI). A magnetic resonance imaging (MRI) scan of the spine will check for possible nerve damage.

If your child is a candidate for the MACE procedure, he or she will have surgery that creates a way to deliver enema fluid to the large intestine. The appendix is used to build a passageway from the belly button to the large intestine. The enema fluid is inserted through a catheter in the belly button using a gastrostomy button. The enema is given to clean out the colon.

The MACE procedure is highly successful at resolving constipation and fecal incontinence. Once your child's condition is corrected, you can expect:

• Reversal of the procedure. The MACE procedure can be reversed because the colon is left intact.
• Removal of the button. The gastrostomy button can be removed.
• Return to normal. Bowel movements will return to normal.

The MACE Program drastically changes the lives of the children it treats. After the MACE procedure, children say they enjoy:

• Improved quality of life
• An increased interest in eating 
• Increased calorie and nutritional intake

The MACE Program completed a published quality-of-life study of its patients and documented an increase in the average quality-of-life rating after device placement. The study found:

• Lower quality-of-life rating before treatment. An average quality-of-life rating of 64 percent before the procedure.
• Improved quality-of-life rating after treatment. Quality of life improved to a 90 percent rating six months after surgery.
• Maintained higher quality-of-life rating a year later. At 12 months post-procedure, patients rated their quality of life at 92 percent.

Children are monitored at the twice-monthly MACE clinic. Your child's doctor will see him or her three months after the procedure and then every three or six months depending on your child’s condition.