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Page last updated:
12 November 2021
Anal irrigation is a procedure where water is introduced through the anus to assist bowel evacuation. It may be recommended by specialists only when other less invasive methods of bowel management have failed to adequately control constipation and/ or faecal incontinence.
A full continence assessment will be completed by specialist services (NHS Bladder and Bowel Care team) prior to considering anal irrigation systems. The NHS Bladder and Bowel Care team are responsible for initiation, patient training, and regular review of patients (at least annually).
Independent or non-NHS nurses may be involved in individual patient assessment, communication with the GP will be in conjunction with the NHS specialist team.
Following specialist assessment, GPs may be asked to prescribe anal irrigation systems.
GPs should not make product and accessory changes without discussing with the NHS Bladder and Bowel Care team; any changes must be on specialist service recommendation only.
Choice of system is patient specific and individualised depending on a number of factors, including disabilities; dexterity; cognitive ability; ability to sit on the toilet; ability to carry out the procedure independently; volume of irrigation required; and the nature of the bowel dysfunction.
Patients should be informed that they have a free choice of route of supply e.g., via community pharmacy or dispensing appliance contractor etc.
The systems are usually recommended for daily or alternate day use. Cones and rectal catheters are single use (expected usage is therefore 15-30 per month); water bags are changed approximately monthly. Specific details of required products (and monthly quantities) will be provided to GPs by the specialist team.
Mild and transient symptoms, such as abdominal pain, chills, nausea and minor rectal bleeding, may occur during or after irrigation. There is also an extremely rare risk of potentially fatal bowel perforation. Specialists should provide comprehensive training to patients/carers on how to use the specific system, how to recognise the symptoms of colonic perforation, and what actions to take.
If a patient is ordering excessive quantities or reports difficulties, please contact NHS Bladder and Bowel Care service for further advice.
These systems consist of a cone that is inserted into the anus, and a small hand pump. They are small, discreet systems that are used when only a small volume of water is required.
They are often used to help either start or complete evacuation and can be used for patients with ileoanal pouch dysfunction (on consultant surgeon recommendation) or for mucous build up in the rectal stump of patients with a stoma. They can be used with an extension tube to increase the volume of water, or for patients who have reduced flexibility (e.g. obesity, back or shoulder problems).
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For use whilst the patient sits on or over the toilet or a commode. These systems consist of a disposable cone and an integral water bag/tubing/hand pump.
The patient needs the ability to hold the cone in the anus whilst the water is instilled either through gravity (hanging the water bag above shoulder height) or via the hand pump. Due to the cone having to be physically held in situ, these systems are not frequently used when a third party (e.g. nurse or carer) is delivering irrigation.
A self-retaining cone may be necessary for some patients, specialists will advise.
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For use whilst the patient sits on or over the toilet or a commode. These systems involve a rectal catheter with an integral balloon, which is inflated to hold the catheter in place in the rectum. This helps to achieve a seal to assist retention of irrigation fluid.
These systems are often used when a patient does not have the mobility or dexterity to hold a cone in the anus at the same time as using the hand pump, when a third party (eg community nurse or carer) is performing irrigation for a patient, or where assessment shows that a cone based system is not suitable for the patient.
Rectal catheters are single use only and all are hydrophilic coated so the patient will not usually require additional lubricant products.
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These systems use an electronic pump to control the flow of water into the rectum (rather than a hand pump). There is both a cone and a catheter/balloon based system. Due to the high initial cost of providing the pumps, these are only used under special circumstances (e.g. for individuals with limited dexterity/grip, who are unable to manage a manual pump system).
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