www.incontinentsupport.org

Hey folks,

For the past few months, my bowels have been doing increasingly poorly: where they used to move once a day every morning, they're now sluggish, unpredictable, increasingly firm, and difficult to hold in for more than a few moments when the need arises. The neurologist I've been seeing about my tethered spinal cord suggested that I use regular fiber supplementation and, when necessary, stimulant laxatives to make sure I'm not going more than 48 hours between BMs.

For the past two weeks or so, it's been working fine; 2 fiber caplets twice a day, and a couple bisacodyl at bedtime every other day. The next morning, it works its magic right as I stand up and get out of bed. Since I'm already changing and hopping in the shower immediately after, not being able to hold it in hasn't inconvenienced me terribly yet.

Two days ago, though, the bisacodyl kicked in while I was still sleeping, and I woke up to a ripe-smelling (though thankfully contained) crime scene that took at least 20 wipes to clean up. Despite my eating and sleeping schedule not changing prior, I figured it was a fluke, and continued the same regime. Today, the normal BM came upon first standing up, and I assumed everything would be fine. But in the evening, an unexpected accident of equal size happened while I was bending over to pull laundry out of the dryer.

Needless to say, I'm concerned about going to work tomorrow if a BM could happen while I'm there. Does anyone have any tips on how to keep regular in the face of a stubborn bowel?

My GI specialist has me using enemas when bowel timing is difficult or unpredictable. Understand, my situation (gastric paralysis) is not the same as yours. But, if your doctor approves, you might consider giving it a try. Good luck.

Hi Jacob,

Sorry to read about your problem.

We have similar problems as I am double incontinent. My bowel incontinence is due to chronic severe constipation that causes overflow diarrhea.

I use daily morning enemas to control my bowel incontinence. These are old-fashioned saline and soap ("soapsuds") enemas administered from a hanging red rubber bag, not the chemical Fleet enemas.

Why enemas? An empty colon simply cannot have a bowel accident. Enemas are always effective - very effective, if done correctly. I can choose the time most convenient to me in and administer the procedure in the privacy of my own home. When done, I can stop worrying about bowel incontinence until the next morning.

Enemas never should be administered while sitting on the toilet. That would be the most uncomfortable position for an enema as you would be fighting gravity. Try lying flat on the floor on towels placed over rugs.

The use of enemas, often called trans-anal irrigation or retrograde irrigation in medical papers, is a recognized conservative (non-surgical) treatment for the management of fecal incontinence. All of my colorectal surgeons and primary care doctors have approved of this.

How effective are enemas in reducing bowel accidents? That can vary significantly from person to person, but I now average a fecal accident every month or a bit more. I just went six weeks without a fecal accident

My doctors would not have approved of the heavy doses of bisacodyl every two days. However, after prescribing increased fiber, they prescribed Polyethelene Glycose (PEG) (a brand name is Miralax). In smaller doses, PEG just softens the stool to prevent constipation and "helps" you go but does not "make" you go.

To reduce the risk of an accident for special occasions you might take a single tablet of Loperamide (not two) before breakfast in the morning to slow down transit time. However, that should not be done every day as it could contribute to your problem.

Please discuss all of the above with your physician.

--John

Thanks for the info! My neuro was the one to suggest bisacodyl, and I never take more than 5-10mg, but I do have an appointment with a GE in a week, so I'll be sure to ask him too.

I've tried enemas up to 1 litre, and my only issue (aside from the cramping) is that I can't seem to get it all out in one go. I'll fill up, try to hold it, sit down and try to push it out. Wait until I can't feel anything left, stand up, and guess what? There's more! Repeat that 3-4 times, then get in the shower, and the last drops tend the come out there by the end.

I'll give you, it's effective, but very time-consuming!

Time consuming? Indeed, that is my experience exactly. However, if you're patient, and nobody else need to use the bathroom, it works.

Jacob,

As I have self-administered over 3,400 enemas for medical reasons, I have learned a few tricks to make it safe, comfortable, and effective procedure. We all have had the problem of an enema "getting stuck" and sometimes draining at the wrong time. I will wait to post some more tomorrow as I have just the solution to your problem of retained enema. I can't go into it right now as I have to get ready to leave to go teach English as a Second Language to migrant Latinos in a nearby rural area. It is my labor of love and they learn English while I improve my rusty Spanish.

Meanwhile, go to the Articles section of the ISC site, and look under "other." You will see my white paper "Preventive Enemas for the Control of Fecal Incontinence." You might start reading that. The URL is:
http://www.incontinentsupport.org/Preve ... inence.pdf

I am in the process of massively revising that paper with many updates and additions, so please ask any questions here or by PM.

--John

Jacob,

I forgot to ask what kind of enema solution are you using? Do you add soap to the solution? If so, what kind and how much? What is the approximate temperature of the water?

How high do you hang the bag?

What body position(s) are you using during or after the enema?

Do you retain the enema? If so, for how long?

1 quart of enema solution really is a small amount for your main or primary enema. That is why traditional enema bags have been manufactured to hold 2 quarts for the past 100 years. The additional quart of solution is more effective at removing fecal matter. It also is less likely to result in an enema being “stuck.” 1 quart of enema solution may not remove enough fecal matter and some of the solution may remain in the colon, blocked by stool that was not eliminated. A 2-quart enema is more effective, and because of that, less likely to become “stuck.”

Enemas getting “stuck” and not completely expelling within a reasonable amount of time is not uncommon for many people. However, in my research I found a solution in old nursing handbooks from the 1940’s and 1950’s (the “Golden Age” of enemas) – the use of a final cool or cold enema to prompt the release of any retained enema solution. This method was commonly used in hospitals during the period cited. I use this “trick” myself when I cannot wait around and must leave the house for an appointment soon after completing an enema. Obviously, I want to avoid the risk of potentially embarrassing “delayed drainage.”

I mention this trick in my white paper on the use of preventive enemas to manage fecal incontinence.

A cool or cold final rinse (second rinse) will not aid much in preventing fecal incontinence, but it can help avoid annoying, embarrassing, and much dreaded late drainage after the enema is over. This is an old nurse's trick.

It is helpful to make the final rinse of saline water cool or cold in temperature (never use ice water) - cool water is 65 to 85 degrees F; cold water is considered to have a temperature of 50 to 65 degrees F. I must emphasize that this final cool or cold rinse (a third enema), is totally optional as it primarily affects possible late drainage from the previous enemas rather than fecal incontinence itself.

The colder the temperature of the water is, the more effective it will be. However, it also may be more uncomfortable. You will have to determine your own tolerance vis-à-vis the desired results.

The cooler water stimulates the colon to contract and release any remaining water from the previous warm enemas – and, very often, additional waste. After the cool water is expelled, you then may feel warmer water remaining from the previous enema also being expelled.

The rate of fill for a cool water enema may be noticeably slower than with a warm water enema as the walls of the colon do not relax as they do with warmer water. You may need to hang the bag just a bit higher to compensate for this effect.

A cool or cold water enema can be smaller in volume than the primary soapsuds enema or the rinse – often 500 ml to 1.0 L (1 pint to 1 quart). The smaller volume may be infused by repeated insertions using a bulb syringe, if desired.

Excessively cold water is unnecessarily uncomfortable and very difficult to retain. As a cold water enema can produce almost immediate peristalsis with very strong results, no period of retention is necessary. By using this technique I was able to experience 180+ enemas sessions without any late drainage after leaving the bathroom. Your success may vary.

Another thing you might do after the bag is empty and you have clamped the hose, is to remain on your right side for the first 2 minutes or so of your retention period. Then rotate from right to left sides, pausing for about 1 1/2 minutes for each side. This will cause the enema solution to flow back and forth in the colon, further loosening any stuck stool. Loosening any stuck stool also will aid in expelling the enema solution.

Discuss enemas with your physician, but don’t expect him to be very knowledgeable on the subject. My gastroenterologist told me that I knew more about enemas than he did.

If you decide to try the above, I would recommend that you do it on a weekend. A weekday morning before you leave for work is no time to experiment with enemas.

Good luck!

--John