Further Information
The bed system is suitable for patients who:
- have poor balance and are unable to transfer onto a toilet or commode
- are confined to bed
High volume bed irrigation:
- Irrigate daily
- Instil 200mls and release. Allow water to flow into bag, replace stopper and repeat (maximum of 3 irrigations)
- Irrigate with as much water as tolerated, up to a maximum of 800mls in 1 go
More information Qufora IrriSedo bed here.
Established users of rectal irrigation who become pregnant:
A clear and documented discussion with the multi-disciplinary team (MDT), about continuing with irrigation during pregnancy, is recommended.
Starting irrigation during pregnancy is generally not advocated, and should be delayed until after the birth of the baby. However, individual circumstances may warrant further MDT discussion.
Studies have shown that rectal irrigation is safe to use. Teaching your patient how to use the equipment safely and advising on how much water to use and how often to irrigate will reduce the risks.
Rectal irrigation can be associated with passing sensations of:
- Bowel discomfort
- Nausea
- Shivering
- Fatigue
- Sweating
- Headache
- Light bleeding from the rectum
There is a potential complication of bowel perforation. This is very rare (1 in 500,000). Following the instructions for use will reduce this risk. Your patient should see immediate medical attention if they think they have a perforation.
There is a potential complication of bowel perforation. This is very rare. Following the instructions for use will reduce this risk. Your patient should seek immediate medical attention if they think they have a perforation.
- Bowel perforation is very rare (1 in 500,000)
- 67% occurred within 1st 8 weeks of use
- Risk not increased with long term use
- Add reference Global perforations 2016
To reduce risk:
- Thorough assessment
- Structured training
- Use as instructed
- water volume
- frequency of irrigation
Rectal irrigation is an effective solution for bowel problems which:
- Relieves constipation
- Prevents faecal incontinence
- Reduces bloating and abdominal discomfort
- Is easy and hygienic to use
- Is effective for all types of bowel dysfunction
Studies have shown rectal irrigation to be effective for up to 60% of patients with a range of bowel problems, including functional bowel conditions (Henderson et al 2022) and neurogenic bowels (Christensen et al ??).
Rectal irrigation helps your patient regain control of their bowel movements, increasing confidence and improving quality of life, allowing them to live life to the full, without the worry of unpredictable bowels.
Symptom improvement using RI for Functional Constipation (Etherson et al 2017)
Regular follow up with patient is important to ensure adherence, establish routine and troubleshoot any problems.
Recommended frequency of follow up is (see follow-up questions section):
- 2 – 4 weeks
- 4 – 6 weeks
- 8 – 12 weeks. Discharge with patient-initiated contact.
Once settled into a routine, alternate day irrigation may be possible. This will be based on individual assessment.
Review regime – ensure daily, is timing of irrigation convenient, check compliance
Is volume of water – is it not enough / sufficient / too much?
What are the results – presence of stool / brown or clear water?
Does evacuation feel adequate?
Irrigation technique – address any problems, using equipment correctly?
Supplies – regular and timely orders being received?
Adjust regime as required – consider alternate day irrigation
Encourage to persevere
If not responding to irrigation after 3 months – may require alternative system and /or discuss at MDT for other treatment options OR onward referral to Consultant.
To be considered at initial assessment and during ongoing use of rectal irrigation.
Use rectal irrigation only after careful discussion with relevant medical practitioner under the following circumstances:
- Inflammatory bowel disease (e.g. Crohn’s disease or ulcerative colitis)
- Active perianal sepsis (fistula or abscess, third or fourth degree haemorrhoids)
- Previous rectal or colonic surgery
- Diarrhoea of unknown aetiology
- Faecal impaction / rectal constipation
- Severe autonomic dysreflexia
- Severe diverticulosis or diverticular abscess
- Abdominal or pelvic irradiation
- Long term steroid therapy
- Anticoagulant therapy
- Low blood sodium
- Previous severe pelvic surgery
- Colonic biopsy within past 3 months
- Use of rectal medications for other diseases which may be diluted by irrigation
- Congestive cardiac failure
This list is not exhaustive, individual patient factors should also be considered.
To be considered at initial assessment and during ongoing use of rectal irrigation.
Irrigation should not be used under the following circumstances:
- Known anal or colorectal stenosis
- Colorectal cancer / pelvic malignancy pre-surgical removal
- Acute inflammatory bowel disease (e.g. Crohn’s or ulcerative colitis)
- Acute diverticulitis
- Within 3 months of anal or colorectal surgery
- Within 4 weeks of endoscopic polypectomy
- Ischaemic colitis
This list is not exhaustive, individual patient factors should be considered too.
Aim to use sufficient warm water to achieve a feeling of adequate evacuation.
It is recommended that patients begin by irrigating once daily, for a minimum of 2 weeks, at a time to suit them. This allows familiarisation with the equipment and the procedure and also allows the patient to get into a routine which fits their lifestyle.
Patients can be encouraged to try irrigating at different times of day, with up to a maximum of 1000mls of water.
Since bowels respond best to a regular routine, the preference is to irrigate at a similar time each day. Irrigating 20 – 30 minutes after a meal may take advantage of the gastro-colic reflex, improving results.
Review parameters (frequency, water volume) at each scheduled follow up. Consider changing to alternate day irrigation.
Laxatives
- Continue to take oral laxatives when rectal irrigation is started
- Stop using suppositories or enemas when rectal irrigation is started
- When routine is established consider reducing oral laxatives
Antidiarrhoeals e.g. Loperamide
- Continue to take antidiarrhoeals when rectal irrigation is started
- When routine is established consider reducing antidiarrhoeals
- Prepare /assemble the equipment
- Show patient each component, fill with water, connect parts, prime system, lubricate cone or catheter
- Instil water
- Expel water
- Demo to patient – patient to reciprocate
- Follow manufacturers step by step guide
Next steps:
- Order equipment (individual companies will provide information on ordering)
- Send GP letter
Assessment of the patient before initiating rectal irrigation will:
- Confirm the reason for starting irrigation, for example inadequate response to other conservative therapy
- Ascertain the optimal product for a patient to use
- Identify the presence of any cautions or contra-indications for the use of irrigation
Assessment should include digital rectal examination prior to starting rectal irrigation, ideally within 48 hours of the first irrigation, so that irrigation can be performed safely.
The following factors should be assessed prior to starting irrigation:
- Toilet position /evacuation technique
- Stability / balance on toilet
- Hand function – dexterity / strength / wrist flexibility
- Body habitus / buttock contour / size
- Psychological function – cognitive / language / visual
- Examination features / perianal sensation / anal tone
- Medical /surgical history
- Home environment
- Availability of care provision (if carers are required to assist)
