What is antegrade colonic enema (ACE) surgery?

Antegrade colonic enema surgery (ACE) or Malone antegrade colonic enema (MACE) is a procedure that is designed to help empty the bowel of feces. The procedure allows the emptying of the bowel by using fluid (similar to an enema) that is inserted into a small opening in the side of the abdomen rather than into the rectum.

Why is antegrade colonic enema (ACE) surgery performed?

The reasons for the surgery include problems such as constipation and fecal incontinence. These problems may be caused by many conditions. They may be congenital (present at birth) abnormalities that affect the rectum and anus, or they can be caused by neuropathies (nerve supply problems) that result from spinal abnormalities.

When is antegrade colonic enema (ACE) surgery performed?

ACE surgery is performed when other methods to control constipation or fecal incontinence have not been successful. These other methods might include bowel training, dietary changes, medications taken rectally (suppositories or enemas), or medications taken by mouth.

How often should the bowels be emptied?

Most people use their ACE once daily, but a few need to use it only every other day. An irrigation may take 30-60 minutes. It is important to stick to a routine and empty your bowels at approximately the same time every day. Approximately 30 minutes after a meal is a good time to empty the bowels, as the colon has increased activity and good clearance of bowels is more likely.

Last reviewed by a Cleveland Clinic medical professional on 12/16/2017.


  • Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet. 1990;336:1217-1218.
  • Bruce RG, el-Galley RE, Wells J, et al. Antegrade continence enema for the treatment of fecal incontinence in adults: use of gastric tube for catheterizable access to the descending colon. J Urol 1999;161(6):1813–6.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy