Hints and Tips with Transanal (rectal) Irrigation

Transanal irrigation can take some time to get used to and it is normal to not get great results to begin with! However, with time and patience your results should improve. The following hints and tips may help you troubleshoot any problems, to help you get the best results possible from your irrigation.

Pain when irrigating

It is normal to experience some abdominal cramping when you irrigate – this tells us that the bowel is being stimulated and is contracting to move the stool along the colon. There are some tips that may help make the procedure more comfortable for you:

• Ensure the water is warm enough, cool water will worsen cramping. The water should be lukewarm and should feel comfortable when it is going in, rather than chilly.
• If pumping the water in results in pain, you may be going a little too fast. Pause for a while and then continue more slowly.
• If cramping continues to be an issue for you despite the above tips, speak to your healthcare professional, who may be able to recommend some antispasmodic medications to help.
• If the pain is severe STOP IMMEDIATELY, REMOVE THE ANAL CONE OR DEFLATE THE BALLOON AND REMOVE THE CATHETER (depending on the type of system you are using). If the pain persists for more than a few minutes or is accompanied by a lot of bleeding, seek medical help immediately.

Passing water around the anal cone/rectal catheter

This can happen in the early days of irrigating, if the rectum is full of constipated stool or when the rectum is not used to the feeling of being irrigated. As your irrigation routine starts to establish you are likely to find this becomes less of a problem. In the meantime the following ideas may help:

• Ensure you are holding the anal cone in place firmly (for cone based systems).
• Ensure you have inflated the balloon on the rectal catheter properly (for catheter/balloon systems) and that you have gently pulled the catheter down after inflation, to provide a seal in the rectum.
• Try adjusting the angle of the cone or rectal catheter in your bottom.
• Slow down the speed of instilling the water, or take a pause.
• Follow your Healthcare Professionals advice on continuing any laxative medications.

Expelling the balloon (catheter/balloon systems only)

• The catheter balloon can cause rectal contractions, which in turn may cause the catheter balloon to expel. Many people believe that in order to overcome this, you need to inflate the catheter balloon further; however you need to do the opposite and decrease the catheter balloon size. Return to a catheter balloon size of approximately 2-3 and increase slowly until the catheter balloon is just being held in place.
• Instil the water slowly, checking that the water is not too hot or cold.
• Expelling the catheter balloon is more likely to happen if you irrigate after a meal;

try a different time.

• If the catheter balloon is deflated: check for a burst balloon. Practice inflation technique with a catheter outside the body in the first instance.
• Remember to store your equipment at room temperature and away from humidity, as this can affect the balloons
• For women with impaired sensation or difficulty with your hands, ensure you have not mistakenly inserted the catheter into the vagina.

Bleeding

Occasional spots of bright red blood may be seen on the catheter, especially if you have haemorrhoids. This is not a cause for concern. If bleeding is occurring regularly, report this to your health care professional. If you have a sudden major bleed, seek urgent medical attention.

Feeling feint during or after irrigation

Occasionally irrigating can make you feel unwell, either during or immediately after irrigation (when you evacuate your bowels). It is not uncommon to notice a little sweating or palpitations. You may even feel a little dizzy or light-headed until you get used to the procedure. If you are affected in this way, you should try to make sure that there is someone you can call for help if needed.

Not passing the water following irrigation

This can be a sign of dehydration. Ensure you are drinking at least 1.5 litres per day, more if the weather is hot or if you have been very active.

Water is passed but no stool

If you had a good result last time you irrigated, there may not be any stool in your bowel. You may need to irrigate less often if this is happening regularly.

If you have not had any results for several days, you may have become constipated and your stool may be very hard and impacted. If this is the case you may need to start/increase laxatives – your Healthcare Professional can guide your with this. Regular use of irrigation can help prevent this from happening again – return to daily irrigation until your results improve again.

Water or stool leakage after irrigation

It may be necessary to wear a small pad when you first start irrigating as you may experience leakage until you establish a routine and learn from experience that this will no longer happen.

• Try sitting on the toilet longer to make sure that you are empty.
• Remember to use a foot stool and any other techniques your Healthcare Professional has taught you
• Try using more water
• Try using less water
• If you are losing a bowel motion between irrigations, you may need to irrigate more frequently.
• An anal plug or insert may help if the problem persists.

Special information for people with spinal injuries

If you have a spinal injury at or above T6 and are prone to autonomic dysreflexia, always ensure that you have your medication to hand when you irrigate. If you notice any autonomic dysreflexia symptoms, stop the procedure, deflate the catheter balloon and remove the catheter.

What happens if my medical condition changes or I have bowel or abdominal surgery?

You should stop irrigating and consult your Healthcare Professional before recommencing.

Can I travel with the irrigation equipment?

Yes! However, you should use bottled or cooled boiled water in places where the tap water is not safe to drink. Remember that in different time zones your body may take a while to adjust to a new routine. Your diet may also be different and this can affect your usual bowel motions. Your Healthcare Professional can provide you with travel information and a certificate to make your journey through airport security easier.

Remember – take your time. Establishing a good bowel routine with irrigation sometimes takes time and patience. If you are finding it difficult, do persevere.  Keeping a bowel diary of how much air you are using (for catheter/balloon systems), how much water you are instilling and what the results were is very useful for both yourself and your Healthcare Professional when reviewing your irrigation progress.

With acknowledgement to Ann Cornelius, Pelvic Floor Nurse Specialist, Plymouth University Hospitals Trust for her kind input in this article.