Transcript Anal irrigation - Bradford District Care Trust Continence Service
Aims of the session
• Types of patients • Assessment • Bowel management • Types of anal irrigation • Case studies • Outcomes and issues
Bowel problems
• Slow transit • Chronic constipation • Obstructed defaecation • Faecal incontinence • Spinal problems • Head injury • Multiple Sclerosis
MS
• 85,000 MS sufferers in UK (Fowler et al 2008) • 3:1 women:men (Fowler et al 2008) • 75% will experience constipation and/or faecal incontinence (MS Society 2010) • 50% incontinent of faeces in past 3 months • 20-30% incontinent of faeces at least once a week. (Krogh & Christensen 2009)
Bowel management
• Diet and fluids • Exercise if possible • Osmotic laxatives • Stimulant laxatives • Suppositories/enemas • Irrigation • Anal irrigation recommended by NICE (2007)
Home visit
• Luxury of time • Comfort of own home • Holistic assessment • Medical and surgical history • Medication • DVD and information
Types of irrigation
• Cone system • Electrical pump system • Rectal catheter pump system
Pump cone system
Qufora • Patient holds cone in place • Performed on toilet • Water and faeces empty into toilet
Pump Cone system
Biotrol pump • Patient holds cone in place • Pump assists flow of water • Performed on toilet • Water and faeces empty into toilet
Catheter system
Peristeen • Rectal catheter held in place by balloon • Water pumped into bowel • Performed on the toilet • Water and faeces empty into toilet when balloon released
Referral pathway
• Cone system – assessment by suitably trained healthcare professional • Rectal catheter system – must be assessed by a doctor with appropriate knowledge and skills before commencing irrigation • MDA alert – risk of perforation • 1:100,000 – minimal risk
Never teach irrigation to the following patients:
• Acute inflammatory bowel disease • Known obstructing rectal or colonic mass • Rectal or colonic surgical anastamosis within the last 6 months • Severe cognitive impairment (unless tolerated and carer able to supervise/administer) • Pregnant or breastfeeding
Proceed with caution
• Spinal cord injury at or above T6 – risk of autonomic dysreflexia – 1st two irrigations must be supervised • Unstable metabolic conditions – renal or liver disease • Physical or cognitive disability/mental or emotional disorder • Anorectal conditions that cause pain or bleeding (e.g anal fissure, 3rd degree haemorrhoids)
Proceed with caution
• Pregnant or planning pregnancy • Any bowel or abdominal surgery within the last 6 months • Acute diarrhoea • Anal fissure • Large haemorrhoids that bleed easily • Past pelvic radiotherapy which has caused bowel problems • Severe diverticular disease • Rectal medications for other diseases • Congestive cardiac failure • Anal surgery within the past 6 months
Home visit
• Ensure exclusion criteria discussed • Ensure risks and benefits discussed • Demonstrate kit • Documentation and consent • Patient performs irrigation • Information and re-ordering • Contact details • Follow-up
Positive impact
• Reduced toileting time • Clean and quick • Improved confidence • Quality of life • The word gets round!
• Check suitability first
Issues encountered
• Acceptance • Not for everyone • Confidence • Dexterity • Frequency of use • Abdominal cramps • Volume of water • Balloons bursting • Catheter falling out • Leakage of water • Support from companies
Sally age 52
• MS diagnosed 15 years ago • Our patient 2 years for bladder symptoms • Disclosed bowel problems • Occasional faecal incontinence • Constipation • 3 hours a day bowel care • Using laxatives and suppositories • Digital stimulation and removal
Sally
• Reluctant to go out • Depressed and isolated • Life revolved around bladder and bowels • Thought nothing else was available • DVD and information about irrigation system
Sally
• New lease of life • Half hour bowel care • Reduced laxative use • Increased activity • Forgets about bowels for rest of day • Happier • Massive impact on QOL
Thank you
Maria Moor Continence Nurse Specialist 01274 322171 Maria [email protected]