A number of people have asked me about this, so thought I would put it together as a blog post sharing my experience so far. I share a lot about my bladder so I would hate for my bowels to be left out!
Please note: This includes information I have been told by my medical team, information I have researched myself and includes my own personal experience. This is only for information and should not be substituted for advice from your own healthcare professional.
What is colonic irrigation/rectal irrigation?
As google so delicately puts it, and as the helpful example sentence shows (lol) it is the practice of using water to flush out the colon as a tool for bowel management.
Note that it is water, not coffee or any other homemade naturopathic concoction you may have heard in the wellness world. Only water should be used, as any other substance can be harmful.
Some may have heard of people using 'colon cleansing' as a way to flatten their stomach or improve their gut health or even claim to cure bowel cancer (which it can't). The idea is that it can wash out any toxins. But research shows that we don't need to do that, as thats literally what our gut does for us. In fact one risk with colonic irrigation is that it can even wash out some of our good bacteria that we need for our gut health. It could also lead to tears, electrolyte imbalances and and infection. Current research only supports the use of colonic irrigation in the appropriate medical setting. I do not know why you would want one unless you really needed to have it.
It is also not to be confused with other methods of emptying your bowel such as enemas and suppositories. Although it can end in the same result (hopefully you poop), the mechanism of how it works is quite different.
Why would you need it?
As already mentioned, although relatively safe it can cause complications and should only be used under medical guidance for conditions it is known to be beneficial for. This could be due to chronic constipation, those who need help with bowel management due to bowel incontinence or those with spinal cord injurys/paralysis.
With chronic constipation, it can be difficult to empty your bowels. In my case, I have two issues contributing to constipation due to Ehlers Danlos Syndrome:
1. Gut dysmotility - waste products cannot move through my digestive tract and into my colon as nothing moves
2. Evacuatory dysfunction - once waste products eventually get to my rectum (with help from medication) I am unable to empty anything out
In terms of bowel incontinence, it helps as it enables the patient to fully empty their bowels so there is nothing left in the colon for 24-48 hours. This means they are unlikely to have a further accident if they do colonic irrigation daily.
How does it work?
It works by inserting a small rectal catheter which is attached to a water bag. You slowly pump water into your bowels either until you feel the feeling of 'fullness' or with the prescribed amount of water by your doctor. You then remove the catheter and sit on the toilet, allowing the water to expel out along with any bowel movements that the water pushes out.
The two main brands I have heard of that are commonly used are Qufora and Peristeen. Withing these companys there are different types such as the mini which is more of an enema size, to full bags that hold 800ml water. You can also have some rectal catheters that have balloons that inflate to hold it it in place. I will take you through what I do using Qufora 'Irresedo cone', and here is a video with the process for a Peristeen version.
1. Fill the water bag with room temperature water
2. Open the rectal catheter and run it under water to activate the lubricant
3. Attach the rectal catheter to the bag without touching the lubricated part
4. Open the valve and let water drain out to prevent air bubbles
5. Hang bag off hook provided above toilet seat if you want to use gravity and not the pump
6. Sit on the toilet, carefully insert rectal catheter
7. Hold in place with one hand, whilst using the other to pump in water (usually 500ml max)
8. After required amount, remove the rectal catheter and stay over the toilet
9. Expel the water and any bowel movements with it
10. Repeat if needed or if you for example only put 250ml in, repeat twice
11. Place the catheter in a the bag and seal and dispose, drain water out of bag and store
It is an invasive procedure due to inserting the cone/probe rectally, but once shown how to do it the risks are minimal and the benefits can really improve your quality of life. There is limited research but overall it seems to show that colonic irrigation is an effective tool for bowel management (Hsu et al, 2016) (Patterson, 2012) (Emmanual et al, 2013)
How do you get one?
I can only speak of my experience in the UK and the NHS. I was recommended to use colonic irrigation initially by one of my gastroenterologists as I wasn't opening my bowels for weeks. I kept ending up in A&E with bowel impactions, going through the fun game of how many suppositories and enemas can we put in Zoe and she still won't be able to open her bowels!
I initially put it on the back burner for a few months as I was concerned re: the effect on my gut bacteria - which have already been destroyed by antibiotics. Plus I kind of couldn't face having yet another THING as I was struggling with my catheters a lot then. But as things continued to decline, my womans health/pelvic floor physiotherapist gave me one to trial and it was such a game changer. From there it was then prescribed to me and I get a monthly delivery from Qufora. (I know Peristeen is another brand that works in a similar way). You use one water bag a month and change the rectal catheter each time, so you will need regular supplies if it is for daily use.
My experience and tips
On my very first try, I had a bowel movement and it was like magic. Prior to trying it I wasn't that keen, I could only imagine it would hurt and add more pain and rectal tears like enemas often do. Yet the rectal catheter is quite small and feels okay, and you are in control of how much water you put in which helps as you can build up your confidence/get used to the sensation. Overall I 100% prefer it to having to rely on suppositories and enemas and its much easier to use than you initially think.
It won't 'work' every time and thats normal - your bowel movements will still depend on a number of factors such as diet, partly depends where things are sitting in your bowel (aka for me often everything is stuck higher up). But also it needs regular use for it to become more effective. They recommend doing it roughly the same each day or every other day
Use body temperature water - sometimes I have been too lazy to wait for the water to warm up (UK problems) and used cold water which just sends off my bowel into spasms. Or I have stayed at places with seperate taps for cold and hot and have sometimes get the ratio wrong and its been too hot. Thankfully not hot enough to injure myself, but still not very comfortable
Expect water to go everywhere - Even know almost a year in, I still get it wrong some times and end up with a crazy hose spraying water all around the bathroom. Sometimes I haven't turned the water off or I drop the tube or when I am emptying the excess water, manage to spray it everywhere. One tip is to use a puppy pad or incontinent pad by the toilet which makes clearing up water spray easier!
Keep a regular routine - Even if I know there is nothing ready to leave, I still do colonic on a daily basis. This is because it helps the whole colon to move things along and keeps that regular pattern going to help with consistent emptying
It might not 'fix everything' - so this would be discussed with your medical team anyway, but just in case you were under the impression that this will fix all your issues, it might not. For me I still take numerous laxatives and motility drugs to get my bowels moving and colonic is just the end point! I still have pain, bloating and crazy spasms, but I have been able to stop using enemas and suppositories though which is a big bonus.
Its nothing to be ashamed of - own it! It's what I need to use to open my bowels and have a better quality of life. It isn't gross, you don't get covered in your own faeces and its a very clean procedure. I find it gives me a lot more dignity than some of the nights I had in the bathroom before using this. Plus its severely reduced the amount of times I have multiple doctors and nurses putting things up my bum which is more invasive!
I hope thats been helpful! If you have any other questions then please email me on activelyautoimmune@gmail.com and I am more than happy to help.
Lots of love, Zoe xx