About Irrigation

Bowel function

For most people emptying their bowel is not a problem. However, we understand that many people may find bowel management has a massive impact on their quality of life.

Faecal incontinence and constipation and a long time spent on bowel management can lead to anxiety, depression and social isolation.

Rectal irrigation can help to relieve these problems, allowing you to live a full and happy life again – free from the worry of bowel accidents and constipation.

Constipation

Symptoms of constipation can present as infrequent bowel movements, straining, a sensation of incomplete evacuation and the difficult passing of hard stool. This may cause other issues such as bleeding, haemorrhoids or anal fissures.

Faecal Incontinence

Faecal incontinence is unplanned bowel movements or bowel accidents. Incontinence can occur with soft/watery stools, but also with hard stools. Constipation and incontinence can occur at the same time when fluid leaks around stool that is stationary or moving too slowly.

Important

Always fully assess the patient before starting rectal irrigation and ensure you have read and understand the indications and instructions for use.

How are people affected?

Living with bowel problems can severely affect your patients’ quality of life – both in their personal life and in their decreased ability to perform and plan their work life. People of all ages can experience bowel problems, from children to the elderly. For all it can be a problem that impacts massively on their quality of life. Bowel problems are still a taboo subject to most people. Therefore, unfortunately, some do not seek or receive help to treat their condition.

Poor overall health as well as medication use in general are strongly related to bowel problems. Trauma to and systemic diseases of the nervous systems are often followed by severe constipation and faecal incontinence, often taking many hours a day to try to control.

Obstetric trauma can result in life altering faecal incontinence with women.

Constipation can result in;

– abdominal pain
– discomfort and bloating

Faecal incontinence leads to;

– embarrassment
– possible social isolation
– depression

Faecal incontinence or constipation is reportedly suffered by as much as one in three of community-dwelling adults 65 years or older. Furthermore, more than half of nursing home residents suffer from faecal incontinence or constipation. People who suffer from faecal incontinence and/or constipation often become isolated. Their life is controlled by their bowel management. Rectal irrigation gives them a solution to help get them back in control of their life. Faaborg P: Long-term impact of transanal irrigation and spinal cord injury on bowel function. PhD dissertation. Faculty of Health Science, Aarhus University, 2011.

Who can be helped with rectal irrigation?

– Neurogenic disease or injury e.g. spinal cord injury, multiple sclerosis
– Chronic faecal incontinence
– Chronic constipation
– Elderly who are immobile or those confined to bed for long periods

What is rectal irrigation?

Rectal irrigation (sometimes called anal irrigation or trans-anal irrigation) has been practiced for many hundreds of years. Over recent years it has been more widely used by the medical profession as a bowel management solution for their patients. It simply involves instilling warm tap water into the rectum via the anus and then allowing the water to be expelled, thus emptying the colon. Studies have shown that regular rectal irrigation can be an effective solution* to prevent faecal incontinence and constipation. It can also reduce the amount of time spent on bowel management, improving patients’ quality of life, dignity and self esteem*. It is a very effective method of clearing the bowel and maintaining bowel function. Rectal irrigation should be performed regularly (usually daily or every other day) to achieve full continence and prevent constipation**. Rectal irrigation provides reliable bowel management, it is easy, quick, effective and hygienic to use, and results in an increased quality of life for your patient. *Reference: Christensens P, Colonic irrigation for disordered defecation, Doctoral thesis Aarhus University, 2009 **Reference: Shandling B & Gilmour RF 1987

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What does the patient want:

– Easy to use solution
– Hygienic and time saving
– Prevent faecal accidents and constipation
– Confidence
– Improved quality of life

The solution of rectal irrigation:

Control of defecation: Regain control of bowel activity.

Prolonged continence period (24-48hrs): Allowing confidence to live life to the full again.

Increased patient well being: Reduced symptoms of nausea, fatigue, lack of appetite and bowel accidents.

More hygienic: May reduce risk of urinary tract infection.

Reduced time spent on bowel management: On average, patients spend 15-30 minutes on bowel management every day or every other day.

Overall improved quality of life: Better health and improved well-being in general.

How effective is rectal irrigation?

When using conservative methods of bowel management such as manual evacuation, only the distal part of the bowel is generally emptied (figure 1). When using rectal irrigation, the bowel has been shown to empty to the splenic flexure(figure 2).

Using warm water rectal irrigation can successfully empty the bowel so that a further irrigation does not have to take place for another 24-48 hours.

Studies have shown that using trans-anal irrigation is superior to using conservative bowel management methods for individuals with neurogenic bowel dysfunction, regarding long term symptoms and improved quality of life.

Reference: Christensen P et al. Scintigraphic assessment of retrograde colonic washout of faecal incontinence and constipation. DisColon Rectum 2003; 46:68-76

Other benefits

Those with disordered defaecation can also benefit. Trans-anal irrigation represents a simple, reversible option if conservative bowel management regimes are unsuccessful, and therefore should be considered before more drastic surgical procedures are considered.

Research also suggests encouraging results in children with spina bifida or severe constipation.

Therefore irrigation should be considered for bowel dysfunction in these patient groups, before potentially irreversible surgery is undertaken.

Reference: Christensen P, Krogh K, Scand J.Transanal irrigation for disordered defecation:a systematic review. 29 Gastroenterol,45:517–527. 2010

Is it safe?

Rectal irrigation is safe to use if a few simple rules are followed:

• A qualified health care professional should undertake a thorough bowel assessment before starting the patient on irrigation. They should be there when they perform at least their first irrigation to ensure they complete and understand the process.

• Always follow the instructions for use. This will reduce the risk of bowel perforation, which although rare, is a potential complication of using irrigation. If this occurs, your patient should seek immediate medical attention.

• You may need to modify the amount of water used and the frequency of irrigation to achieve the suitable regime for the patient.

Some minor side effects might occur, such as:

• Minor abdominal pain, nausea, light bleeding or fatigue

Long term use

With proper assessment, training and follow up, rectal irrigation can be successfully used by adults and children who suffer from bowel dysfunction.

It has been found that no anorectal deterioration was shown as the result of year-long continuing use of rectal irrigation in people who suffered faecel incontinence or constipation. Trans-anal irrigation has also been shown to have a good safety profile when used long term*, and also to manage the long-term symptoms of defecation disturbances**.

*Reference: Faaborg PM, Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction, et al. Spinal Cord, 47: 545-549. 2009 ** Gosselink MP, Long-term follow up of retrograde colonic irrigation for defecation disturbances, et al. Colorectal Disease, 7:65-69. 2005