Aims of the session
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Types of patients
Assessment
Bowel management
Types of anal irrigation
Case studies
Outcomes and issues
Bowel problems
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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)
Bowel management
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Diet and fluids
Exercise if possible
Osmotic laxatives
Stimulant laxatives
Suppositories/enemas
Irrigation
• Anal irrigation recommended
by NICE (2007)
Home visit
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Luxury of time
Comfort of own home
Holistic assessment
Medical and surgical
history
• Medication
• DVD and information
Types of irrigation
• Cone system
• Electrical pump system
• Rectal catheter pump system
Pump cone system
Qufora
• Patient holds cone
in place
• Performed on
toilet
• Water and faeces
empty into toilet
Pump Cone system
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Biotrol pump
Patient holds cone
in place
Pump assists flow
of water
Performed on
toilet
Water and faeces
empty into toilet
Catheter system
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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 disease
• Known obstructing rectal or colonic mass
• Rectal or colonic surgical anastamosis within
the last 6 months
• Severe cognitive impairment (unless tolerated
and carer able to supervise/administer)
• Pregnant or breastfeeding
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
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Pregnant or planning pregnancy
Any bowel or abdominal surgery within the last 6 months
Acute diarrhoea
Anal fissure
Large haemorrhoids that bleed easily
Past pelvic radiotherapy which has caused bowel problems
Severe diverticular disease
Rectal medications for other diseases
Congestive cardiac failure
Anal surgery within the past 6 months
Home visit
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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 impact
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Reduced toileting time
Clean and quick
Improved confidence
Quality of life
The word gets round!
Check suitability first
Issues encountered
• Acceptance
• Not for
everyone
• Confidence
• Dexterity
• Frequency of
use
• Abdominal
cramps
• Volume of water
• Balloons
bursting
• Catheter falling
out
• Leakage of
water
• Support from
Sally age 52
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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
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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
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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
Thank you
Maria Moor
Continence Nurse Specialist
01274 322171
Maria Moor@bradford.nhs.uk