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Enema, enemas & irrigation for paraplegia
Other rectal laxative aids, in addition to the suppositories and microenemas, are the option of flushing the bowel. This is a more invasive procedure because water is introduced into the intestine through the anus. Various bowel irrigation techniques are presented below.
This article is the continuation of "Rectal Emptying Aids - Correctly Administering Suppositories for Neurogenic Intestinal Dysfunction" and explains the possibilities of colon irrigation for neurogenic bowel dysfunction.
When are colonic irrigation indicated for paraplegia?
Colon irrigation has a wide range of uses in practice. On the one hand, they are carried out in the intestine before surgical or diagnostic measures or in fasting cures / therapeutic fasting to detoxify (see: therapeutic fasting: restart for the soul). In the area of neurogenic intestinal dysfunction, intestinal irrigation indicates either faecal incontinence or constipation in order to loosen and flush out the ball of feces. The symptoms appear depending on the level of paralysis:
- High paralysis cause defecation disorder and defecation disorder. The reflexes are intact, but the tone of the sphincter and pelvic floor muscles increases. Therefore, the bowel movement is not carried on and can only be eliminated with supportive measures.
- Deep paralysis are associated with fecal incontinence, as the reflexes of the sphincter muscle, pelvic floor and stool excretion are disturbed. The intestine is flushed and as long as it is not filled again, the person is stool continent.
Effect of colonic irrigation
Colon irrigation is extremely effective because it works in multiple ways. The flushing of the intestines does one mechanical Stimulus, triggered
- Through the foreign body (intestinal tube)
- Due to the pressure of the incoming liquid
- By the amount of flushing liquid
The temperature of the enema also plays a decisive role, it is what causes the thermal Stimulus through
- Lowering the temperature to around 30 to 35 degrees: there is a strong stimulus (risk of cramps)
- Raising the temperature to around 38 to 40 degrees: a weak stimulus is created (rarely used)
In addition to water, other chemical Additives trigger a stimulus. These are, for example, ready-mixed mixtures with an osmotic effect, such as Yal® or Praktoclyss®.
What is an absolute no-go and should by no means be practiced is the use of additives that are not declared for the use of colonic irrigation. You can often read in forums that olive oil, milk, coffee, herbs, Schüsslersalze, base powder, curd soap, etc. are added to the rinse water. The fact is that such substances can irritate the sensitive intestinal mucosa and are not approved for colonic irrigation. It is also questionable how much of the substances remains in the intestine and what negative effects this has on intestinal health in the long term.
When should enemas not be given?
While there are certain situations in which an enema is indicated, there are also specific clinical pictures or conditions in which an enema must not be administered. Detailed information on this is given in the package insert or a doctor must be consulted. Acute abdominal and lower abdominal diseases as well as injuries in the area of the anus are listed most frequently.
Complications of giving an enema
It is important to proceed carefully when inserting the intestinal tube / tube. If the catheter cannot be pushed in any further, it must never be pushed against resistance. It makes sense to push the catheter back a few centimeters and try again. There is a risk of injury from improper insertion of the catheter in the form of a perforation in the intestine.
Since some types of enema are very stressful for the circulation, the patient's condition must be recorded during the enema. The patient must be informed of the risks and encouraged to report changes immediately. Blood pressure controls may be required. It is also helpful for the patient if he can rest for a while after the enema.
Giving an enema
In the case of paraplegic people, a distinction must be made as to whether the enema can be performed independently or nursing support is required. The prerequisite is that the person can hold the tube / intestinal tube and push it in with feeling. If this is not the case, a second person is required. While it is basically possible to pass the enema in the back, right or left side position with bent legs or in the four-footed stance, with nursing support the left side position in bed is preferred as far as it is comfortable or practicable for the person concerned (with bent legs) is. Left is explained on the basis of the anatomical course of the intestine. The water can then be flushed in deeper. Either the complete evacuation procedure then takes place lying down, or after the water has been introduced, the patient is transferred to the commode or to the toilet. When performing independently, e.g. B. irrigation, the person sits on the toilet or the toilet chair from the start and also introduces the water into the intestine there.
What types of enemas are there?
Enema syringe pear-shaped
The enema syringe corresponds to a mini enema system. Body-warm water is drawn into the balloon, the amount varies between 100-300ml, depending on the manufacturer. The water from the balloon is flushed into the intestine via a cone inserted into the rectum. The aim is for the water to soften the stool and thus trigger the evacuation reflex. It is suitable for colon cleansing and constipation. In addition to low expenditure, low costs are also an advantage, since the product can be used multiple times.
Enema / enema
Enemas are ready-made solutions with certain additives. For example, the Freka Clyss® enema, a ready-to-use disposable salt-based enema. A certain dexterity is required, because the cap and tip are first greased with Vaseline, then the tip is removed / broken off. To prevent the liquid from running out, the hose must be kinked, ideally with your fingertips or a clamp. In a preferred position on the left side, the tube is inserted carefully and as deeply as possible and the 120 ml of liquid is allowed to run into the intestine under slight pressure. The bowel is emptied within 10 to 20 minutes. The enema can also be warmed to body temperature in a water bath before administration. It should be noted that overdosing can lead to a disruption of the electrolyte balance. Unless otherwise prescribed by the doctor, it is intended for single use. Detailed instructions can be found in the instructions for use. (Instructions for use as of: 11/2009)
Rectal catheter with irrigation
So-called intestinal tubes or rectal catheters are intended for the entry of liquids, but also for the discharge of gases to the outside. The intestinal tubes are available in different sizes from Charrière 16 to 40 (= 5.33 to 13.33 mm) and in lengths from 20 to 40 cm and are for single use. Compared to catheters, single-use intestinal tubes are less flexible so that they can be better inserted and advanced into the intestine. The choice of the intestinal tube depends on the indication. In order to make the insertion of the intestinal tube as less stressful as possible for the patient, it is coated with a lubricant. In the case of severe flatulence, an intestinal tube inserted through the anus can divert some of the intestinal gases into a connected bag and relieve the intestine. The intestinal tube remains in the intestine for a maximum of 30 minutes, because a longer period of time can lead to pressure points in the intestine. Disposable bag systems are used when liquids enter through an intestinal tube. The amount of water or any additives are based on the doctor's instructions. In the intestine, the liquid causes slight pressure on the intestinal wall, so that the peristalsis of the intestine is additionally stimulated.
Reprop® rinsing system
Reprop® consists of a liquid container that contains 750 ml, with a ventilation valve, an extension tube with a non-return valve and an intestinal tube. The vessel is similar to a plastic drinking bottle and can be squeezed with your fingers. Body warm water is filled into the vessel. Sitting on the toilet, the liquid is introduced through the intestinal tube provided with lubricant. The valve mechanism allows easy manual pumping of the fluid container until all of the fluid has been introduced into the intestine. The system can be used several times after cleaning. Further information at http://www.reprop.de
Anal irrigation system / transanal irrigation
Anal irrigation is a further development of the well-known enema. It is prescribed by a doctor and requires instruction in handling by professionally qualified personnel. There are various irrigation systems on the market, for example the Qufora® system from MBH International, Peristeen® from Coloplast or Irrimatic R from BBraun. The utensils except for the rectal catheter can be used several times; detailed information can be found in the package insert. A
Peristeen® complete system
System usually consists of one
- Rectal catheter with balloon
- Water tank
- Control unit
The water tank is filled with approx. 500 ml body temperature water. The rectal catheter is inserted into the rectum while sitting on the toilet, as it has a hydrophilic coating, so no additional lubricant gel needs to be used. The balloon on the rectal catheter is "inflated" via the control unit and the anus is closed (blocked). This way the catheter stays in place and the introduced water can no longer escape. Alternatively, a cone can be used instead of a catheter with a balloon. However, this must be held by hand the entire time. The water enters the intestine either by gravity or controlled by the device. It should stay there for about three minutes until the balloon of the rectal catheter is deflated and the rectal catheter is withdrawn from the rectum. Shortly afterwards, the “softened” stool is excreted with the water. If necessary, the procedure can be repeated two to three times at intervals of at least 15 minutes.
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