Stories Pouch irrigation and catheterisation demystified
By David Davies – RLG Chairman
This article aims to demystify the techniques of pelvic pouch irrigation and catheterisation, which are used by some pouchees to achieve full pouch emptying. RLG member Claire has kindly produced a series of short, educational videos which provide a very practical guide on to how to use, clean and store the system – in this case the Qufora Irriseto flow enema – for the benefit of pouchees who might be contemplating irrigation and catheterisation as part of their pouch management. Other systems are available, for example the Aquaflush system by Clinisupplies in the UK. These more sophisticated systems have flow valves instead of bulbs, which are more user friendly and help to eliminate air from the system. But you could also use a simple enema bulb, available from Amazon and other outlets. By way of a contrast, RLG Membership Secretary Gary has produced a short video to demonstrate the use of one of the simplest systems on the market – the Medena catheter.
Perspective
It is difficult to find information on how many pouchees practice irrigation and catheterisation; on a straw poll of the monthly zoom pouch forums only 2 of 15 attendees practiced it routinely. In general, it is used to help emptying in situations where spontaneous emptying is challenging (for example with a stricture) or indeed where pouchees want to fully empty. Some pouchees might have an innate aversion to such practices, but it is useful to be informed from an experienced users and we hope these videos will therefore be of interest to all pouchees.
Claire’s Story
Claire had her pouch surgery in 1997 due to UC and reports that it was pretty much “plain sailing” (barring surgery for adhesions) until around 2016. Then she started getting issues with frequency, cramping and very disturbed nights due to incomplete emptying as a result of strictures (one below the pouch and two above). She searched the internet for “J pouch not emptying” and up popped the Red Lion Group. Claire reports that the articles and the posts gave her hope that she could avoid a permanent stoma and she also received some coaching via text from RLG member Ben Barbanel on the irrigation process, something she had no idea about before discovering RLG.
Claire reports “it is an absolute game changer, I can go out all day and not worry about pouch logistics. I also discovered that many of the foods I thought I could not eat just needed to be chewed properly, so they are back on the menu. I was intimidated by irrigation to start with, but it now takes just 15 minutes at either end of the day.” Perhaps most striking are Claire’s subsequent comment that she is still confused as to why she had to find this out herself and why she wasn’t directed by medical professionals. And she is happy to share the details of irrigation and catheterisation in case it helps other pouchees. A nice comment on the value of RLG and in particular to Ben Barbanel, a genial and eloquent advocate for a healthy pouch.
Incomplete emptying of a pouch can lead to increased frequency, increased urgency, discomfort, a bloated feeling and can lead to pouchitis. Incomplete emptying before bed also increases the likelihood of having to get up in the night; so the ability to completely empty the pouch is a priority for pretty much every pouchee.
Some pouchees are less able to spontaneously evacuate their pouch, for example if they have a stricture (narrowing) above and/or below the pouch. Claire comments that she has three strictures; one below her pouch and two above the pouch. In such cases, the use of a catheter with or without pouch irrigation might be a good, non-surgical option which enables full emptying.
The Medena catheter will be familiar to many pouchees who use it to fully evacuate the pouch in cases where spontaneous evacuation is not occurring. Sometimes, however, the stool can be too solid to easily pass, even when a catheter is inserted. This can happen if you are eating high insoluble fibre diets for example, and/or dehydration to name but two reasons. In such cases the pouch might benefit from a “flush” to liquidise the contents of the pouch using an irrigation device, which involves squirting some liquid (typically warm water) in to the pouch using an irrigation device. Gary explains how to use the Medena catheter with flushing in his video below –
Pouch irrigation and catheterisation are discussed extensively by Ellie Bradshaw in three webinars she recorded for Red Lion Group in recent years and which are available to download from the RLG website and also from our YouTube channel. Ellie was the Head of Biofeedback at St Mark’s Hospital and is an expert at assessment of pouch function and resolution of performance issues. She comments that complete emptying can be a game changer for many pouchees who suffer with frequency and/or urgency.
If you look back in the Roar archives on the RLG website you will find that Roar! Issue 39: Christmas 2008, included the results of a survey on Medena catheters, which showed that 17 of 23 pouchees with some degree of functional outflow obstruction reported an improvement of quality of life when using the catheter. Furthermore, our own Christopher Browne wrote of his joy and relief at his own “catheter conversion”. See https://pouchsupport.org/my-catheter-conversion/
For those pouchees who might benefit from using a catheter, there are lots of practicalities to consider up front – what equipment do you need to irrigate and catheterise? How do you carrying this equipment around in a discrete way? How do you clean the equipment after use?
Claire has produced an excellent series of six short videos that will answer all of these questions and help you to visualise exactly how to use, wash and store the paraphernalia safely and discreetly. The clips are as follows:
- Medena catheter – description and use (1min 19sec) The volume of water in your enema will be personal to you and what feels comfortable / effective for you. Claire suggests starting with a small of water in your enema and build up.
https://youtu.be/aQDlV43ypyg
- Qufora Irrisedo flow enema kit – description, use and storage (2min, 3sec). The catheters do not need to be sterile; Claire uses a bleach solution to store the catheters as this eliminates odours and cleans better than water alone.
https://youtube.com/shorts/XtFEQ5LoJTM - Example set up for catheterisation (i.e after irrigation) (1min 43sec)
https://youtu.be/5yt_xByFaQ8 - Next steps after irrigation (53sec)
https://youtu.be/jDVQd_U3GfM - Clearing up and sterilising (2min 7sec)
https://youtu.be/SxsRx3mwLxc - Kit storage for storage when not in use and for travel, for taking to work, just in case. Claire also suggests the Qufora Irrisedo MiniGo (see below) in case of unexpected irrigation whilst travelling. And you can get two cut down catheters in a toothbrush travel container! (1min 25sec)
https://youtu.be/ntQsf3fP5K4
I hope these videos will help members to better visualise what the irrigation and catheterisation kit can look like and how it is used, cleaned and prepared; how it can be packed for travel and how it can be carried. A huge thanks to Claire and Gary for producing the videos and in the process helping to de-mystify the process of irrigation and catheterisation.
As always, we advise that you check with your medical team to make sure that irrigation and catheterisation are appropriate and correct for you and your condition(s).
David Davies
RLG Chairman
See Link for further information about the Qufora IrriSedo MiniGo & MiniGo Flex. Please note that the Red Lion Group does not endorse or recommend any particular product. In all cases, consult a medical expert or your colorectal consultant about your condition as we are all unique!
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