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Irrigation

Posted by Ajahn, on Mon Sep 02, 2019 4:03 am

I have been practicing irrigation for 4 years now, I had my operation in March 2015. Everything has been going well up until this week where I tried to irrigat and the water flat refused to go in. The first 2 occassions I took a 20 min or so break and it seemed to be successful after that, I had thought constipation as the output was quite thick, thicker than is my normal. I usually irrigate every 2nd day. I did my normal irrigate yesterday and had to wait awhile and start all over again. Today I went on a fast and decided to irrigate again this evening which is my usual time: total failure tried a few times even changed the water tip, gave up after about an hour. Hopefully I can talk to the stoma nurses at Holy Spirit tomorrow. Has anyone out there had similar experiences or any advice. I did have a CT scan of my abdomen and pelvis about 6 weeks ago and all was well. Peace of mind if someone out there has an answer, thank you all in advance and sorry to be long winded!

Reply by Bill, on Mon Sep 02, 2019 5:30 am

Hello Ajahn.
Thank you for your post containing questions about irrigation (or problems with it).
There are various reasons why the water might not go into the stoma as it should and you are right that a blockage such as constipation may well be one of those reasons.
In my own case it was a parastomal hernia, which closed over the hole and blocked it completely. I was rather concerned at first, thinking that I might not be able to irrigate again in future. However, Having poked my finger in the stoma and ascertained that it was a hernia and that was caused by the peristalsis muscles just inside the stoma closing over the hole, I thought that if, instead of using the cone, which ended up on the outside of the blockage, I would try an adaptation to an anal catheter (which I used to use when I had an incontinent anus). I can insert the catheter up to 9inches into the stoma, which clears the blockage and deposits the water on the right side of the hernia.
There are a couple of problems with this method:
1)The catheter (like the finger) needs to be gently but firmly manoeuvred into the stoma and past the obstruction. This is possible because the muscles eventually relax and allow the hole to open (this might be why your irrigation worked on the second try).
2) The gravity water feed did not have enough power to push the water into the stoma. I resolved this by attaching the catheter to a hand pump made from a garden sprayer, which worked very well. (there is an irrigator pump by Braun medical, which does the same job but is expensive and did not have enough water reservoir for my needs. I have also used a portable, battery operated camping shower, which also worked well until it gave up on me and I reverted back to the hand-pump garden sprayer.
3) This brings me to another drawback with pressurised irrigation; Using the anal catheter method creates lots of ‘splashback’, which means that I need much more water in the reservoir than would be in the hanging bag or the Braun arrangement. My container has 3 litres, which is enough to allow for loss of about half of that in splashback.
4) Splashback is controlled by having a rubber washer at a distance along the tube where I don’t want the tube inserted any further. (about 8 inches in my case) I did make a much more elaborate shield to guide the water back down the irrigation tube, but I found that this was not necessary, and the rubber washer did the job just as well.
I have developed these alternatives for myself because I CANNOT ENVISAGE HAVING A STOMA WITHOUT EFFECTIVE IRRIGATION. The very thought of it makes me cringe and I certainly do not envy all our fellow ostomates who do not have irrigation as an option.
If you are seeing your stoma nurse tomorrow, I would discuss the situation with her/him and ask if they could identify the blockage problem so that you know what you are dealing with. If it is a similar problem to my own, then all you need to do is to find a way to get the water past the blockage. The irrigation process will usually get rid of any or most blockages caused by firm output. It might be that you need to consider irrigating every day as the longer output is left in the lower colon, the firmer it tends to become – because the moisture is extracted at that stage.
I will be interested to hear what the outcome of your enquiries are.
Best wishes
Bill

Reply by Puppyluv56, on Mon Sep 02, 2019 12:08 pm

I have had times that nothing came back out even though I was sure a good bit of water went in. I did not have a blockage nor a hernia. It just happens on occasion and may be just due to consistency of the stool. You may want to take a mild stool softener to see if that helps any. I use Citrucel and not a fan of  MiraLax. Take too long.  If you wear a cap, I would plan on a pouch during the time you take the stool softener. Sounds like your scan saw nothing to be concerned about but consulting your physician may be a good idea if the problem persists! 

Puppyluv

Reply by Ajahn, on Mon Sep 02, 2019 4:26 pm
Puppyluv56 wrote:

I have had times that nothing came back out even though I was sure a good bit of water went in. I did not have a blockage nor a hernia. It just happens on occasion and may be just due to consistency of the stool. You may want to take a mild stool softener to see if that helps any. I use Citrucel and not a fan of  MiraLax. Take too long.  If you wear a cap, I would plan on a pouch during the time you take the stool softener. Sounds like your scan saw nothing to be concerned about but consulting your physician may be a good idea if the problem persists! 

Puppyluv


Thank you for your reply Puppyluv, I shall start the ball rolling today with hopefully a visit to the stoma nurse and then an appointment with my surgeon, we hope for good news:the thought of giving up irrigation well???????????

Reply by Ajahn, on Mon Sep 02, 2019 4:33 pm
Bill wrote:

Hello Ajahn.
Thank you for your post containing questions about irrigation (or problems with it).
There are various reasons why the water might not go into the stoma as it should and you are right that a blockage such as constipation may well be one of those reasons.
In my own case it was a parastomal hernia, which closed over the hole and blocked it completely. I was rather concerned at first, thinking that I might not be able to irrigate again in future. However, Having poked my finger in the stoma and ascertained that it was a hernia and that was caused by the peristalsis muscles just inside the stoma closing over the hole, I thought that if, instead of using the cone, which ended up on the outside of the blockage, I would try an adaptation to an anal catheter (which I used to use when I had an incontinent anus). I can insert the catheter up to 9inches into the stoma, which clears the blockage and deposits the water on the right side of the hernia.
There are a couple of problems with this method:
1)The catheter (like the finger) needs to be gently but firmly manoeuvred into the stoma and past the obstruction. This is possible because the muscles eventually relax and allow the hole to open (this might be why your irrigation worked on the second try).
2) The gravity water feed did not have enough power to push the water into the stoma. I resolved this by attaching the catheter to a hand pump made from a garden sprayer, which worked very well. (there is an irrigator pump by Braun medical, which does the same job but is expensive and did not have enough water reservoir for my needs. I have also used a portable, battery operated camping shower, which also worked well until it gave up on me and I reverted back to the hand-pump garden sprayer.
3) This brings me to another drawback with pressurised irrigation; Using the anal catheter method creates lots of ‘splashback’, which means that I need much more water in the reservoir than would be in the hanging bag or the Braun arrangement. My container has 3 litres, which is enough to allow for loss of about half of that in splashback.
4) Splashback is controlled by having a rubber washer at a distance along the tube where I don’t want the tube inserted any further. (about 8 inches in my case) I did make a much more elaborate shield to guide the water back down the irrigation tube, but I found that this was not necessary, and the rubber washer did the job just as well.
I have developed these alternatives for myself because I CANNOT ENVISAGE HAVING A STOMA WITHOUT EFFECTIVE IRRIGATION. The very thought of it makes me cringe and I certainly do not envy all our fellow ostomates who do not have irrigation as an option.
If you are seeing your stoma nurse tomorrow, I would discuss the situation with her/him and ask if they could identify the blockage problem so that you know what you are dealing with. If it is a similar problem to my own, then all you need to do is to find a way to get the water past the blockage. The irrigation process will usually get rid of any or most blockages caused by firm output. It might be that you need to consider irrigating every day as the longer output is left in the lower colon, the firmer it tends to become – because the moisture is extracted at that stage.
I will be interested to hear what the outcome of your enquiries are.
Best wishes
Bill


Hello Bill thank you for your very informative reply. I start the ball rolling today with fixing an appointment with my surgeon as I am sure the stoma nurse will suggest that. I omitted to put in my original post that I had a CT scan done on 29th July 2019 and all was clear as I had had a lot of gurgling and the feeling that my colon was twisting around like a snake. I would be extremely grateful Bill if at some time you could send me some photographs of your set up, my stoma nurse said that having a hernia ruled out irrigation, Thank you in advance and take care of yourself.

Reply by Bill, on Mon Sep 02, 2019 4:58 pm

Hello Ajahn. 

If you go onto my profile you will find a photo of the irrigation set up with the anal catheters and one of the ends attached to the irrigation tube. This should give you an idea of what the setup looks like. The manual setup with the garden sprayer is much the same, except of course it uses a pressurised container instead of a plastic cereal box for the water. 

The method I use was advised against by the medics because there is a chance of perforation on the colon. This is a chance I have been living with for the past 2-3years and not much has gone wrong so far. The watchwords are caution, common-sense and calculated risk. One of the main problems is that there is little or no feeling in the colon, so I am working on the knowledge gained by feeling the inside of the stoma and ascertaining for myself what is going on. It is imperative that a thorough investigation is done before you try the sort of irrigation techniques that I have described. You need to know for sure what it is you are dealing with and then manage the problems accordingly. 

It should perhaps be noted that my own problems were orginally caused by a (crap) surgeon, so I have a very skeptical opinion of some of the professionals in this field. My own solutions to the problems I have faced are purely 'mechanical' and not what I consider to be 'medical'. This is why I feel it is important to make sure that the problems are not caused by a medical condition before starting to try stuff for myself. 

We are all different and whilst I am explaining what I have done to overcome stuff, in no way am I necessarily recommending my own solutions for other people. It is also worth noting that the anal catheters will probably not now be available for general use, but as I only use the tips, this would not hold me back from developing an alternative smooth end to the irrigation tube. The on/off switch is 'borrowed' from the Coloplast irrigation system, which is easy to swap tubes and to provide a design suited to my own needs.

I hope you are able to find solutions to your problems without recourse to DIY. However, when you hae discussed it with your medical staff, you can always come back to me and I will provide more details if that will help. 

Best wishes

Bill  

Reply by newyorktorque, on Mon Sep 02, 2019 5:14 pm
Bill wrote:

Hello Ajahn.
Thank you for your post containing questions about irrigation (or problems with it).
There are various reasons why the water might not go into the stoma as it should and you are right that a blockage such as constipation may well be one of those reasons.
In my own case it was a parastomal hernia, which closed over the hole and blocked it completely. I was rather concerned at first, thinking that I might not be able to irrigate again in future. However, Having poked my finger in the stoma and ascertained that it was a hernia and that was caused by the peristalsis muscles just inside the stoma closing over the hole, I thought that if, instead of using the cone, which ended up on the outside of the blockage, I would try an adaptation to an anal catheter (which I used to use when I had an incontinent anus). I can insert the catheter up to 9inches into the stoma, which clears the blockage and deposits the water on the right side of the hernia.
There are a couple of problems with this method:
1)The catheter (like the finger) needs to be gently but firmly manoeuvred into the stoma and past the obstruction. This is possible because the muscles eventually relax and allow the hole to open (this might be why your irrigation worked on the second try).
2) The gravity water feed did not have enough power to push the water into the stoma. I resolved this by attaching the catheter to a hand pump made from a garden sprayer, which worked very well. (there is an irrigator pump by Braun medical, which does the same job but is expensive and did not have enough water reservoir for my needs. I have also used a portable, battery operated camping shower, which also worked well until it gave up on me and I reverted back to the hand-pump garden sprayer.
3) This brings me to another drawback with pressurised irrigation; Using the anal catheter method creates lots of ‘splashback’, which means that I need much more water in the reservoir than would be in the hanging bag or the Braun arrangement. My container has 3 litres, which is enough to allow for loss of about half of that in splashback.
4) Splashback is controlled by having a rubber washer at a distance along the tube where I don’t want the tube inserted any further. (about 8 inches in my case) I did make a much more elaborate shield to guide the water back down the irrigation tube, but I found that this was not necessary, and the rubber washer did the job just as well.
I have developed these alternatives for myself because I CANNOT ENVISAGE HAVING A STOMA WITHOUT EFFECTIVE IRRIGATION. The very thought of it makes me cringe and I certainly do not envy all our fellow ostomates who do not have irrigation as an option.
If you are seeing your stoma nurse tomorrow, I would discuss the situation with her/him and ask if they could identify the blockage problem so that you know what you are dealing with. If it is a similar problem to my own, then all you need to do is to find a way to get the water past the blockage. The irrigation process will usually get rid of any or most blockages caused by firm output. It might be that you need to consider irrigating every day as the longer output is left in the lower colon, the firmer it tends to become – because the moisture is extracted at that stage.
I will be interested to hear what the outcome of your enquiries are.
Best wishes
Bill

 

 

I dont irrigate but I enjoyed reading about your innovations regarding the process.  You're obviously well versed in this department.



Reply by Shitt Happens, on Wed Sep 18, 2019 4:23 pm

Good afternoon Ajahn,

If it can help you, me before introducing the cone for irrigation, I put gel on my index and I introduce it into my stoma to expand it, it helps enormously Smile Smile

Reply by Ajahn, on Thu Sep 19, 2019 6:43 am
Shitt Happens wrote:

Good afternoon Ajahn,

If it can help you, me before introducing the cone for irrigation, I put gel on my index and I introduce it into my stoma to expand it, it helps enormously Smile Smile


Hello and thank you for the advice, I had started to do that after having visited my stoma nurse and the surgeon who took the knife to me. Both had pronounced that there was nothing out of the ordinary though I am still convinced that things have moved and changed down there. So as you advised I start with the little finger and then use the index fingure then sort of lie back and think of England! I live in Australia. I never had this carry on up until now but all's well that ends well as they say. Good luck to you an thank you again.

REgards

Tom.

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