Resolving the problems of rectal stump mucus is a new concept for me as I have only recently had a colostomy and this has been a 'side-effect' (more precicely a rear-end effect).
As will be seen from my profile I don't normally enter into conversational type correspondence. However, I do 'document' some things that I find interesting and rectal stump irrigation is one such subject. Some of you might have come across similar problems and have not been able to control it as well as I am now doing. Thus, I will share this chapter of my life with you. However, the sharing process does not imply that this method will suit everyone or anyone else. It is a solution I have found for by myself, for myself. I am prepared to share my ideas with potential comercial developers or just anyone who wants to give it a go.
I did try to download some photo's of the devices I have developed but this blog doesn't seem to want to enable photo downloads.
There will be another, separate post concerning stoma irrigation and overcoming some of those problems. I hope some of you will appreciate this.
Developing Rectal Stump Irrigation with SOCSAPINE.©
This chapter is a sequel to the previous chapter entitled ‘Shit or Bust’, where I shared some of the experiences of living with faecal incontinence’. (a long story involving bodged operations, faecal incontinence, rectal prolapse and other stuff)
Having had an unsuccessful attempt at pinning up a rectal prolapse, the pain and ‘inconvenience’ was becoming too much to reasonably cope with.
My consultant suggested that a colostomy would ‘sort out all those problems’ and, as I could not carry on as I had been doing, a colostomy was performed.
The operation and recuperation went well and I quickly got into irrigation, which was more convenient for my lifestyle than keep emptying bags.
The colostomy operation was performed by ‘keyhole-surgery’ and simply enabled the surgeon to pull the colon out through the abdomen to form a ‘stoma’. The rectal end was sealed and left in situ to form what I now know as a ‘rectal stump’.
Prior to the colostomy operation I had undertaken my usual tour of the internet to see what was entailed. All the indications were that this was an effective operation with very few unpredictable side effects. However, nowhere did it mention ‘rectal-stumps’ and their possible side effects.
The ‘rectal-stump’ produced enormous amounts of disgustingly smelly, sticky, mucus which proved more difficult to control than the original faecal incontinence. Consequently, whilst the colostomy itself was a success and performed as expected, I felt that the original problem of incontinence had not been resolved as I was now incontinent of mucus which was not manageable.
Having returned to the internet and looked up ‘rectal stump’ I found that I was by no means alone in suffering with the mucus discharge problem.
In the subsequent discussion with my consultant/surgeon, he told me that if it continued, the only realistic solution was to undergo a major operation to remove the stump altogether. This was not an option that I would undergo lightly as surgical procedures are not really on the top of my priorities.
Back to the internet – only to find that the anal stump removal also has it’s potential disasters. Other medical solutions for mucus- management had been tried by many sufferers but the impression was that they were rather unpleasant and did not work that well.
Time for a rethink and, having a penchant for inventing pragmatic gadgets, I set about trying to find a solution of my own.
This of course fits in with my philosophy of SOLAR ( Self-Organised Living And Reflecting) and the treatment I invariably prescribe for my own patients of a prolonged course of SOCSAPINE ( Self-Organised Common Sense Alongside Participation In Normalisation Experiences).
Apart from inventing acronyms, I have a simple, common-sense approach to developing pragmatic solutions to problems which is summarised in my articles on SPASE (Specified Problems & Alternative Solutions Exercise) The idea being that first you identify the problem or problems, then you can look for alternative solutions. So here goes for the problems of anal stump mucus management.
The mucus is prolific and uncontrollable. Anal plugs do not work because some of the mucus is liquid rather than solid – it seeps around the plug. The rectal prolapse still pushes out the anal plugs and some of whatever else that’s up there. The mucus has characteristics including simultaneously having a hard, soft and liquid form. It ‘stinks’ like a dog’s anal glands. (but you can’t squeeze it out as you would for a dog) It comes it a variety of colours, some of which indicate that there might be blood present. ( I had thought of making an ‘artwork’ out of it but that might need to wait until my motivation turns in that direction) Incontinence pads help but are not a good solution as they don’t contain the smell and the liquid form sometimes spurts out beyond the pad. There is a build-up of the more soft and solid mucus in the stump I have no muscles in the stump in order to potentially expel the mucus The pain from the prolapse has diminished but comes back intermittently.
There are a few other potential problems to be considered before embarking upon gadget design and development . Firstly, all my inventions have to be developed on a shoestring and utilising what may be available in the shed as my pension does not stretch to buying lots of new stuff for prototypes.
Also my wife wants me to throw away what I’ve already accumulated and not buy anything else which she deems as ‘junk’.
Then it must be born in mind that the anus is a relatively delicate internal organ that can be damaged if not treated with ‘respect’.
I did not try to test any of my prototypes until after the six-week period of convalescing, at which time the stoma was deemed to have healed sufficiently for me to irrigate. I figured that the rectal-stump would also need a similar time to heal before I could safely start experimenting with pragmatic gadgets.
1) The first thing I tried was the irrigator supplied for the stoma - this did not work because the viscosity of the mucus was not affected by the water. In fact it made the problem less manageable because more liquid was being held in the stump to evacuate later.
2) I then tried the Coloplast anal irrigator which I had left over from my previous anal irrigation days. This had the advantage of being hand pump-driven with a bit more pressure. This also did not work for the same reasons as above
3) I thought that the mucus needed to be allowed or forced to cling on to some alternative other than the walls of the rectal stump. I could then pull that alternative down along with the mucus.
4) I did try Tampons but they did not work because the mucus was not being absorbed by the fabric and it came off the tampon as I pulled it through the anal opening. Thus, still leaving it within the anal stump.
5) The next gadget tried to overcome this problem with a shaped sponge, squashed into a small bore plastic pipe and pushed out into the top of the stump by another pipe behind it. (the same principle as the tampon)
The idea was that the sponge would ‘capture’ the mucus within its’ striations and could be retrieved within the pipe before pulling the pipe from the anus. This gadget worked as predicted. However, it needed to be inserted many times before there was no more mucus on the sponge. Also the sponge needed to be washed out before every new insertion. This was not a viable option as it took far too long.
6) Along the same theme I tried a length of material which could be released in to the rectal plug via the pipe, it would ‘catch’ more mucus and be thin enough to withdraw down the pipe without keep removing the pipe each time. This device worked just like the sponge did. However, the added complication was that the plastic pipe would not stay in the anus whilst I was washing out the material each time.
Alongside this, without a rectal camera, I was not sure what collateral damage I was doing to the walls or the repaired end of the stump.
(A radical rethink was need to overcome the problems of the initial attempts)
7) I returned to the idea of rectal irrigation and tried re-using the Coloplast anal irrigator (end-piece) increasing the pressure by attaching it to a small pond pump. This allowed me to have the right temperature of water in the bidet . This improved design evacuated some of the mucus - but not all.
There was also a serious problem with this device
that I had not anticipated. The Coloplast anal irrigator is designed so that a rubber balloon can be inflated with air within the anus to stop water being evacuated prematurely. Reconnecting the end-piece to a water supply rather than its original bag simply inflated this balloon with water as well as pumping water through the main outlet.
My solution to this problem was to heat-melt and seal that section of the device which served the rubber balloon so that water would only be pumped through the main pipe.
9) My ‘common-sense’ logic was telling me that not all the mucus was being evacuated because the water jets were coming from the sides of the end of the device and were totally missing that mucus that was in the upper regions of the rectal plug. The next step was therefore to cut off the end so that the water was a straightforward jet from the end of the pipe.
(It was at this time that the ancient pond-pump broke and could not be mended.)
10) My solution was to fix the Coloplast end-pieces to 15mm compression straight couplers (standard water pipe fittings) so that the devices could connect straight onto the shower hose in the bath or shower.
This device (or more correctly devices) worked very well. So, with my tendency to use acronyms, I have called the device a ‘SASI’ ( Socsapine’s Anal Stump Irrigator) and here is how it works in practice.
SASI IN PRACTICE
I would have done a video of SASI in practice and put it on utube. However, videoing this procedure would be a two-person job and I have not yet persuaded anyone to be my camera operator. Thus, here is the procedure in prose.
After I have bathed and let the water out, I simply screw the adapted Coloplast end-piece with the straight outlet onto the shower end and adjust the temperature of the water accordingly. The water pressure can be adjusted before inserting the device, although our water pressure is not high pressure and I find that I can have it fully on without adverse effects. I then push the end up the anus so that the water jets around the top of the stump. Then I move it about so that it will clear the whole area around the top of the stump . What is forced out is usually relatively firm mucus. However, because the water is coming straight out of the pipe it does not effectively clean the sides of the rectal stump.
I then change the heads for the (‘adapted’) -normal Coloplast end piece whish blasts the water out of two holes in the sides at the end of the device. This is inserted as far as possible into the rectal plug and twisted from side to side as it is slowly retracted down the anus. This process dislodges the mucus from the sides of the rectal plug. When it reaches the point just before it comes out altogether it dislodges some of the harder mucus which obviously forms at or near the entrance to the anus.
Just one tip and that is when all is done, I stand up and squat down again suddenly. This has the effect of evacuating a residue of liquid mucus that this procedure tends to leave
All this is a messy business - but no more so that irrigating the stoma itself and certainly nothing like the messiness involved with feacal incontinence!
I gain great satisfaction from seeing the enormous amounts of different types of mucus floating its way down the bath to the plughole. However, the greatest satisfaction of all comes from the confidence and knowledge that I won’t be incontinent in this way for a couple of days.
My hope is that this will now be a ‘managed’ problem and that I will not need medications or surgery in the future.
Another success for the common-sense approach of SOCSAPINE.©
Last edited by Bill on Wed Jun 08, 2011 4:50 am; edited 1 time in total