Journal of Gastroenterology & Hepatology
Vol 25 Suppl 2 – Sep 2010
ISSN: 0815-9319
Pg 82 Ref 319
Dry Impacted Stool ~ Slow Transit ~ Colonic Inertia
FEATURES COMMON TO
Dry Impacted Stool ~ Slow Transit ~ Colonic Inertia
HYDRATION ~ ACTIVATION ~ EVACUATION
Therapeutic Potential
Mode of Action
Procedure infuses water into the colon
HYDRATION
soften & loosen DRY IMPACTED STOOL
ACTIVATION
improved TRANSIT/PERSTALSIS
EVACUATION
initiate BOWEL MOVEMENT
Christensen P, et al. Dis Colon Rectum. 2003 Jan;46(1):68-76. Scientific assessment of retrograde colonic washout in fecal Incontinence & constipation.
Instrument Safety
Procedure Safety
Long term safety
Christensen P, et al. Dis Colon Rectum. 2003 Jan;46(1):68-76. Scientific assessment of retrograde colonic washout in fecal Incontinence & constipation.
Faaborg PM, et al. Colorectal Dis. 2010 Jan. Anorectal function after long-term transanal colonic irrigation.
Studies indicating benefits:
Bowel Movement
Relief of Symptoms
Address Patho-psysiology
Improved QoL
Constipation remains a challenging problem. Current management options remain unsatisfactory especially in chronic cases. Colon irrigation is a simple and useful procedure that addresses the patho-physiology underlying constipation. Clinical studies to define its therapeutic potential in the management of constipation should be encouraged.
Vol 25 Suppl 2 – Sep 2010
ISSN: 0815-9319
Pg 82 Ref 319
The management of constipation remains a challenge in clinical practice. Prescription medicine such as the use of laxatives and bulking agents offers some level of relief but are not always effective. Treatment options in chronic cases include biofeedback therapy, colonic lavage and manual evacuation. These too offer only limited and unsatisfactory results (1).
Colonic irrigation using different approaches have been demonstrated to be useful in the treatment of functional constipation (2) (3) (4) and various bowel related problems (5) (9). The procedure infuses water into the colon to facilitate the evacuation of bowel contents. Water hydrates (soften and loosen) bowel contents and activates peristaltic activity resulting in spontaneous bowel movement and evacuation of bowel contents. Although not regularly recommended, studies have demonstrated the beneficial effects of colonic washout in the treatment of constipation and faecal incontinence (6) (7) (8).
With the availability of modern instruments incorporating safety designs that meets F.D.A. guidelines, a more serious look at colonic irrigation as a useful alternative in management of constipation should be considered. Design of instrument also provide for the observation of the discharging waste and offers a more objective means of assessing the outcome of therapy.
In this paper, the results of patients suffering from chronic constipation who have not responded satisfactorily to conventional therapy and had colonic irrigation carried out on them are reported. In the majority of cases, symptomatic relief and improvement were noted. Details of the procedure and the rationale for recommending the procedure will be discussed.
Conclusion: Colonic irrigation can be a useful alternative in the management of constipation. It is a simple procedure yet its therapeutic potential remains unexplored. Clinical studies should be undertaken to ascertain the safety and efficacy of the procedure and to consider its use as an alternative option in the management of constipation.
References:
(1) J. F. Johanson; J. Kralstein. Alimentary Pharmacology & Therapeutics. 2007; Pg 25(5):599-608. Chronic Constipation: A Survey of the Patient Perspective
(2) Gardiner A, Marshall J, Duthie G. Nurs Stand. 2004 Nov 10-16;19(9):39-42. Rectal irrigation for relief of functional bowel disorders
(3) Tod AM, et al. Br J Nurs. 2007 Jul 26-Aug 8;16(14):858-64. Rectal irrigation in the management of functional bowel disorders: a review
(4) McWilliams D. Nurs Standard. 2010 Mar 3-9;24(26):42-7. Rectal irrigation for patients with functional bowel disorders.
(5) Koch SM, et al. Int J Colorectal Dis. 2009 Sep;24(9):1019-22. Retrograde colonic irrigation for faecal incontinence after low anterior resection
(6) Christensen P, et al. Dis Colon Rectum. 2009 Feb; 52(2):286-92. Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence.
(7) Faaborg PM, et al. Colorectal Dis. 2010 Jan. Anorectal function after long-term transanal colonic irrigation.
(8) Christensen P, et al. Dis Colon Rectum. 2003 Jan;46(1):68-76. Scientific assessment of retrograde colonic washout in fecal Incontinence & constipation.
(9) Sacha M. Koch et al. Colonic irrigation for defecation disorders after dynamic disorders after dynamic graciloplasty Int J Colorectal Dis (2008) 32:195-200
A common yet challenging problem
J. F. Johanson; J. Kralstein. Alimentary Pharmacology & Therapeutics. 2007; Pg 25(5):599-608. Chronic Constipation: A Survey of the Patient Perspective
Colonic inertia (slow transit) 75%
Functional outlet obstruction
IBS-Constipation predominant
**Treatment options vary with type of constipation**
Symptom
obvious to patient, may not be bothersome
Problem
may not be obvious to patient, may be considered as not important
Disease
causes discomfort/need relief
Variable symptoms
Associated complaints
Onset type
Severity
Patho-physiology
Drug/Disease related
Primary problem
Constipation
Associated problems
Discomfort, Distension, Gas, Functional problems, Parasites, Yeast, Food intolerance, Flora imbalance, Intestinal permeability, Systemic problem
Contributing factors
Habits, Exercise, Medication, Dentition, Water intake, Fiber intake, Eating habits, Stress
Laxatives | Biofeedback
Colonic lavage | Manual evacuation | Surgery
A Useful Option
Gardiner A, et al. Nurs Stand. 2004 Nov 10-16; 19(9):39-42.
Rectal irrigation for relief of functional bowel disorders.
Tod AM, et al. Br J Nurs. 2007 Jul 26-Aug 8;16(14):858-64.
Rectal irrigation in the management of functional bowel disorders: a review
McWilliams D. Nurs Standard. 2010 Mar 3-9;24(26):42-7.
Rectal irrigation for patients with functional bowel disorders.
Koch SM, et al. Int J Colorectal Dis. 2009 Sep;24(9):1019-22.
Retrograde colonic irrigation for faecal incontinence after low anterior resection
is a variant of enema treatment, which involves flushing of the bowel with water in different quantities, temperature and pressures. Through a tube inserted via the rectum, water may be introduced alone or with added enzymes, coffee, probiotics, or herbs. Treatment sessions usually last about an hour. During a “high colonic,” water goes in through one tube in the colon and is removed along with debris through another tube called an obturator.
Extract from a monograph prepared by professional staff at Natural Standard, based on systematic review of scientific evidence. The material was reviewed by the Faculty of Harvard Medical School.
Christensen P, et al. Dis Colon Rectum. 2003 Jan;46(1):68-76. Scientific assessment of retrograde colonic washout in fecal Incontinence & constipation.
Cleansing
Education
E. Ernst Int Clin Pract. 2010;64(4):429-431.2010 Colonic Irrigation: Therapeutic Claims by Professional Organisations, a Review
Water quality
Controls: Temperature/pressure/flow
Hygiene & Sanitation
Training standards
Adherence to medical guidelines
Following medical protocol
Christensen P, et al. Dis Colon Rectum. 2009 Feb; 52(2):286-92. Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence.
Faaborg PM, et al. Colorectal Dis. 2010 Jan. Anorectal function after long-term transanal colonic irrigation.
