Diseases of the Colon & Rectum

, Volume 40, Issue 7, pp 802–805 | Cite as

Clinical value of colonic irrigation in patients with continence disturbances

  • J. W. Briel
  • W. R. Schouten
  • E. A. Vlot
  • S. Smits
  • I. van Kessel
Original Contributions
  • 61 Downloads

Abstract

Continence disturbances, especially fecal soiling, are difficult to treat. Irrigation of the distal part of the large bowel might be considered as a nonsurgical alternative for patients with impaired continence. PURPOSE: This study is aimed at evaluating the clinical value of colonic irrigation. METHODS: Thirty-two patients (16 females; median age, 47 (range, 23–72) years) were offered colonic irrigation on an ambulatory basis. Sixteen patients suffered from fecal soiling (Group I), whereas the other 16 patients were treated for fecal incontinence (Group II). Patients were instructed by enterostomal therapists how to use a conventional colostomy irrigation set to obtain sufficient irrigation of the distal part of their large bowel. Patients with continence disturbances during the daytime were instructed to introduce 500 to 1,000 ml of warm (38°C) water within 5 to 10 minutes after they passed their first stool. In addition, they were advised to wait until the urge to defecate was felt. Patients with soiling during overnight sleep were advised to irrigate during the evening. To determine clinical outcome, a detailed questionnaire was used. RESULTS: Median duration of follow-up was 18 months. Ten patients discontinued irrigation within the first month of treatment. Symptoms resolved completely in two patients. They believed that there was no need to continue treatment any longer. Irrigation had no effect in two patients. Despite the fact that symptoms resolved, six patients discontinued treatment because they experienced pain (n=2) or they considered the irrigation to be too time-consuming (n=4). Twenty-two patients are still performing irrigations. Most patients irrigated the colon in the morning after the first stool was passed. Time needed for washout varied between 10 and 90 minutes. Frequency of irrigations varied from two times per day to two times per week. In Group I, irrigation was found to be beneficial in 92 percent of patients, whereas 60 percent of patients in Group II considered the treatment as a major improvement to the quality of their lives. If patients who discontinued treatment because of washout-related problems are included in the assessment of final outcome, the success rate is 79 and 38 percent respectively. CONCLUSIONS: Patients with fecal soiling benefit more from colonic irrigation than patients with incontinence for liquid or solid stools. If creation of a stoma is considered, especially in patients with intractable and disabling soiling, it might be worthwhile to treat these patients first by colonic irrigation.

Key words

Colonic irrigation Rectal washout Fecal soiling Fecal incontinence Conservative treatment 

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References

  1. 1.
    Binkley GE. Construction and care of abdominal colostomy. Am J Surg 1952;83:807–91.Google Scholar
  2. 2.
    Iwama T, Imajo M, Yaegashi K, Mishima Y. Self washout method for defecational complaints following low anterior rectal resection. Jpn J Surg 1989;19:251–3.Google Scholar
  3. 3.
    Seow-Choen F, Nicholls RJ. Anal fistula. Br J Surg 1992;79:197–205.Google Scholar
  4. 4.
    Marks CG, Ritchie JK. Anal fistulas at St. Marks Hospital. Br J Surg 1977;64:84–9.Google Scholar
  5. 5.
    Lilius HG. Fistula in ano: investigation of human foetal anal ducts and intramuscular glands, and a clinical study of 150 patients. Acta Chir Scand 1968;383(Suppl):1–88.Google Scholar
  6. 6.
    Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg 1976;63:1–9.Google Scholar
  7. 7.
    Abcarian H. Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy vs. fissurectomy-midline sphincterotomy. Dis Colon Rectum 1980;23:31–6.Google Scholar
  8. 8.
    Hardy KJ, Cuthbertson AM. Lateral sphincterotomy: an appraisal with special reference to sequelae. Aust N Z J Surg 1969;39:91–3.Google Scholar
  9. 9.
    Fussell K. Follow-up of Lord's procedure for haemorrhoids. J R Soc Med 1973;66:246–7.Google Scholar
  10. 10.
    Macintyre IM, Balfour TW. Results of the Lord nonoperative treatment for haemorrhoids. Lancet 1972;1:1094–5.Google Scholar
  11. 11.
    Snooks S, Henry MM, Swash M. Faecal incontinence after anal dilatation. Br J Surg 1984;71:617–8.Google Scholar
  12. 12.
    Goligher JC. Surgery of the anus, rectum and colon. 3rd ed. London: Bailliere Tindall, 1975:116–69.Google Scholar
  13. 13.
    Lewis WG, Martin IG, Williamson ME,et al. Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma? Dis Colon Rectum 1995;38:259–63.Google Scholar
  14. 14.
    Ctercteko GC, Fazio VW, Jagelman DG, Lavery IC, Weakly FL, Melia M. Anal sphincter repair: a report of 60 cases and review of the literature. Aust N Z J Surg 1988;58:703–10.Google Scholar
  15. 15.
    Sultan AH, Kamm MA, Hudson CN, Bartram CI. Third degree obstetric anal sphincter tears: risk factor and outcome of primary repair. BMJ 1994;308:887–91.Google Scholar
  16. 16.
    Briel JW, Schouten WR. Disappointing results of postanal repair in the treatment of fecal incontinence. Ned Tijdschr Geneeskd 1995;139:23–6.Google Scholar
  17. 17.
    Laurberg S, Swash M, Henry MM. Delayed external sphincter repair for obstetric tear. Br J Surg 1988;75:786–8.Google Scholar
  18. 18.
    Keighley MR, Korsgen S. Long-term results and predictive parameters of outcome following total pelvic floor repair [meeting abstract]. Dis Colon Rectum 1996;39:A15.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1997

Authors and Affiliations

  • J. W. Briel
    • 1
  • W. R. Schouten
    • 1
  • E. A. Vlot
    • 1
  • S. Smits
    • 2
  • I. van Kessel
    • 2
  1. 1.Department of General SurgeryUniversity Hospital DijkzigtRotterdamThe Netherlands
  2. 2.Department of StomacareUniversity Hospital DijkzigtRotterdamThe Netherlands

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