Anal Irrigation
Gillian Nottidge
Continence Nurse Specialist
Not a new idea!
History lesson!
• Anal irrigation recorded in Egypt as early as
1500BC! - Egyptian medical document called the
"Eber Papyrus".
• Also known in Africa, Greece, China, Babylonia, and
America.
• people implemented enema treatments in a river by
using a hollow reed to induce water to flow into the
rectum.
• Thought to cure headache, flu, poisoning, measles,
meningitis, constipation, weight management and
many other disorders.
More recently…
Aims of the session
• Types of patients
• Assessment
• Bowel management
• Types of anal irrigation
• Outcomes and issues
• Case study
Bowel problems
• Slow transit
• Chronic constipation
• Obstructed defaecation
• Faecal incontinence
• Spinal problems
• Head injury
• Multiple Sclerosis
MS
• 85,000 MS sufferers in UK (Fowler et al 2008)
• 3:1 women:men (Fowler et al 2008)
• 75% will experience constipation and/or
faecal incontinence (MS Society 2010)
• 50% incontinent of faeces in past 3
months
• 20-30% incontinent of faeces at least
once a week. (Krogh & Christensen 2009)
Home visit
• Luxury of time
• Comfort of own home
• Holistic assessment
• Medical and surgical
history
• Medication
• DVD and information
Bowel management
• Diet and fluids
• Exercise if possible
• Osmotic laxatives
• Stimulant laxatives
• Suppositories/enemas
• Irrigation
• Anal irrigation recommended
by NICE (2007)
Types of irrigation
• Gravity feed cone system
• Electrical pump system
• Rectal catheter pump system
Gravity feed cone system
Qufora
• Patient holds cone
in place
• Gravity assists
flow of water
• Performed on
toilet
• Water and faeces
empty into toilet
Pump Cone system
Biotrol pump
• Patient holds cone
in place
• Pump assists flow
of water
• Performed on
toilet
• Water and faeces
empty into toilet
Catheter system
Peristeen
• Rectal catheter held in
place by balloon
• Water pumped into
bowel
• Performed on the toilet
• Water and faeces
empty into toilet when
balloon released
Referral pathway
• Cone system – assessment by
suitably trained healthcare
professional
• Rectal catheter system – must be
assessed by a doctor with
appropriate knowledge and skills
before commencing irrigation
• MDA alert – risk of perforation
• 1:100,000 – minimal risk
Never teach irrigation to the
following patients:
• Acute inflammatory bowel • Severe cognitive
disease impairment (unless
tolerated and carer able
• Known obstructing rectal to supervise/administer)
or colonic mass
• Pregnant or
• Rectal or colonic surgical breastfeeding
anastamosis within the
last 6months
Proceed with caution
• Spinal cord injury at or above T6 – risk of
autonomic dysreflexia – 1st two
irrigations must be supervised
• Unstable metabolic conditions – renal or
liver disease
• Physical or cognitive disability/mental or
emotional disorder
• Anorectal conditions that cause pain or
bleeding (e.g anal fissure, 3rd degree
haemorrhoids)
Proceed with caution
• Pregnant or planning • Past pelvic
pregnancy radiotherapy which has
• Any bowel or abdominal caused bowel problems
surgery within the last 6 • Severe diverticular
months disease
• Rectal medications for
• Acute diarrhoea other diseases
• Anal fissure • Congestive cardiac
• Large haemorrhoids that failure
bleed easily • Anal surgery within the
past 6 months
Home visit
• Ensure exclusion criteria discussed
• Ensure risks and benefits discussed
• Demonstrate kit
• Documentation and consent
• Patient performs irrigation
• Information and re-ordering
• Contact details
• Follow-up
Positive outcomes
• Reduced toileting time
• Clean and quick
• Improved confidence
• Quality of life
• The word gets round!
• Check suitability first
Issues encountered
• Acceptance • Volume of water
• Not for everyone • Balloons bursting
• Confidence • Catheter falling
• Dexterity out
• Frequency of use • Leakage of water
• Abdominal cramps
• Support from
companies
Sally age 52
• MS diagnosed 15 years ago
• Our patient 2 years for bladder symptoms
• Disclosed bowel problems
• Occasional faecal incontinence
• Constipation
• 3 hours a day bowel care
• Using laxatives and suppositories
• Digital stimulation and removal
Sally
• Reluctant to go out
• Depressed and isolated
• Life revolved around bladder and bowels
• Thought nothing else was available
• DVD and information about irrigation
system
Sally
• New lease of life
• Half hour bowel care
• Reduced laxative use
• Increased activity
• Forgets about bowels for rest of day
• Happier
• Massive impact on QOL
This is real life!
Thank you
Gillian Nottidge
Continence Nurse Specialist
01274 322210
Gillian.nottidge@bradford.nhs.uk