quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth -

"Several problems have been encountered during the establishment of the ACE. The most common is pain during the washout, which is reported in up to 60% of patients. This usually settles spontaneously during the first 3 months but can be helped by reducing the concentration of the phosphate, reducing the rate of the infusion, or using an antispasmodic prior to the enema (such as Colofac, Solvary, UK). Despite regular washouts, patients may still become constipated, which also produces pain and should always be excluded. One of the other problems encountered is the time taken for the enema to pass and achieve a result; this has been a significant contributory factor to failure. The placement of the conduit in the distal descending colon has improved this situation considerably. Patients in whom the standard caecal ACE did not work have achieved excellent results with the left colonic ACE."