Rectal irrigation can be viewed as another way of adminstering rectal enemas to aid rectal emptying in ODS patients.

In my current practice, we use rectal irrigation in ODS patients, when simpler conservative measures alone have failed to achieve satisfactory defaecation & relief of symptoms and before we offer them surgical treatment [in most patients]. There are situations, where irrigation may be used postoperatively in patients with inadequate relief of symptoms after surgery. Conversely there are other situations such as presence of external prolapse & type 3 internal prolapse where surgery is the appropriate initial treatment and will be offered to the patient directly, rather than conservative measures or irrigation, [or when patient refuse to use irrigation].

The term covers a range from the simple use of certain bidets & shower heads to dedicated irrigation kits using inserted intra-rectal catherters such as the Peristeen system

Use of Bidets & toilet shower heads for irrigation:

Use of a jet of water to clean the anus after defaecation [instead of or in addition to toilet paper] is common in parts of the world including, Middle East, Southern European countries, France, Japan, India, South Korea, Brazil, Argentina and many other countries, but is not common in the UK & North America [although increasingly becoming popular]. This water jet comes mostly from the use of shower attachments to toilets, but in many cases from dedicated Bidets. All these [including Bidets, which use vertical jet of water] can also in rectal irrigation to some degree, not as effeciently as using an enema or a Peristeen kit, but it may help patients with mild ODS symptoms, provided one can use a gentle [not fierce] jet of water strategically directed to enter the lower rectum. I don't think this way of irrigation is sufficient except for those with mild symptoms. Discussion of the various types of Bidets is beyond this web site, but briefly they fall into one of the following categories:

• Bidets
• Toilets with built in shower [shower-toilet]
• Shower attachments linked to toilets
• Integrated toilet - Bidets
• Add-on bidet toilet seats. There are many such systems on the market that come with a built in shower attachment, other systems are marketed to convert ordinary toilet to function as a toilet - Bidet, some of the latter function as a toilet seat as well as an electronically controlled bidet,

Use of peristeen transanal rectal irrigation kit

Peristeen rectal irrigation system was developed by Coloplst to aid management of bowel problems in patients with spinal cord injuries and had been established in that setting for several years. We have adopted the use of peristeen system in patients with ODS shortly after its introduction in Spring of 2007, as an easier way of achieving irrigation and as a final trial before offering patients surgery.

Essentially, Peristeen works by instilling lukewarm water into the rectum, using a catheter, a bag and a hand pump. The idea is similar to, but a refined form of old style high enemas [which have become extinct in British hospitals]. The water fills the rectum & distall sigmoid, distending their wall and stimulating the stretch receptors to initiate the urge to defecate and colon & rectal contractions to empty their contents [the water and stool]. The frequency and duration of the irrigation varies depending on individual patient's symptoms. Some patients need to use once or twice per day, others only need to use it every other day. It works better, if the patient can integrate the routine into their daily life.

Irrigation obviously does not suit all patients and it is not possible to predict who will benefit and who would not. Committment to try irrigation for up to 6 weeks is important, because patients need time to get the hang of it. Support from community bowel & continence specialist nurses is absolutely vital in teatching the patient how to use rectal irrigation properly.

There are some relative contraindications to the use of rectal irrigation. These include:

• Congestive Heart Failure, Severe arthritis of hands or elbows,
• Active Inflammatory Bowel Disease [Ulcerative colitis or Crohn's disease affecting the rectum and sigmoid]
• Rectal / low colonic anastomosis or anal surgery within the last 3 months
• Radiation proctitis
• Presence of associated organic pathology in pelvis e.g. Severe DD, Gynae pathology