medena catheter Archives

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!

Stories

My Medena Catheter Conversion

By Christopher Browne
Originally published in ROAR! Issue 39: Christmas 2008.

I’ve just had to pay a large fine for wasting hospital time – or at least I should have done. That’s the view of a stomacare nurse when I told her I’d started using a Medena catheter for the first time.

“Just think, you’ve spent twelve years hanging around in hospital waiting-rooms, going to appointments with puzzled consultants and making worried phone calls about your troublesome pouch when all you had to do was use a catheter,” she told me.

And she was quite right of course. For in 1996 I was given one of these long thin plastic tubes by a nurse specialist at St Mark’s to try and clear my reluctant pouch.

I went home and after eyeing this gangly-looking object a few times, decided to take the plunge. I pushed it up my backside, and waited for some action, but nothing happened. “There must be something stirring in there,” I thought to myself and tried again a few days later. But once again not a drop. Niente. Nothing.

The next day I phoned the nurse specialist who’d given me the catheter and told her I couldn’t get it to work. She was philosophical and said I’d have to find another way to solve my problems.

So I forgot about catheters until earlier this year when I saw Simon McClaughlin, a St Mark’s research fellow, about my pouch-emptying difficulties. He tested, scanned and probed with aplomb as he sought to find the causes. All the results showed a fairly normal-looking pouch. “But I’m having all these blockage problems whenever I go to the loo,” I said. The refrain I’d used with every other consultant I’d visited. He said the various post-pouch ops I’d had for ulcers and dilation had left scar tissue and lesions in parts of the anus.

I had two options. One was to use a Medena catheter. The second was more drastic. Abandon the pouch and have an ileostomy.

I booked an appointment with Beccy Slater, a pouch specialist nurse at St Mark’s. On the day of the visit, Beccy asked me to lie on my side and gently inserted a catheter up my backside. A few seconds later a giant tidal wave cascaded down Harrow-on-the-Hill (at least that’s what it felt like). For my pouch emptied like it had never emptied before as kilo after kilo seemed to pour into Beccy’s red bucket.

“You’re doing well,” she said reassuringly. Then she handed me the catheter and asked me to do the same. I took the plunge and “whoosh” another outpouring. “This is turning into something like fun,” I thought when I realised the catheter really worked after all. Beccy was positively glowing too and I went home a happy man.

That was six months ago. Since then my life has been transformed. I can relax, instead of mildly straining, on the train to work, I can write news stories without having to pause for a comfort – or in this case discomfort – break and I can visit friends and go to dinners, parties and social events feeling upbeat and cheerful. I even went on an eight-hour flight to Miami with no real problems recently.

Why did my catheter conversion take so long? There were two reasons. The first was ignorance. The nurse who first gave me the tube assumed I knew how to use it. However instead of pushing it seven or eight inches up my backside, I’d assumed it started about two inches from my so-called entry-point. So my weak thrusts were in vain.

The second reason was reluctance. No one exactly relishes endoscopes, surgical devices or thin plastic pipes being pushed up their backsides, however many times they might occur. But some are braver, or more determined, than others. I was one of the others.

However Mr Timid has been replaced by Mr Bold. I have used the catheter every day since June this year, visiting the loo two to four times – instead of nine to 10 times – in 24 hours. Each time I use four to six syringes of water (this depends on liquidity and some people may need less) to help ease the stools through. At first I used Lignocaine on the tip of the catheter. I now find wetting it works too.

Each visit takes 9-12 minutes which is only half-an-hour a day. Before I spent at least 90 minutes in the loo. I also find I don’t need to go to the lavatory the normal way anymore. I go just after breakfast and immediately before bedtime and try to fit in at least one visit in between – although I found using a catheter at work tricky at first. My company’s loos are grouped side-by-side with slim partitions between them. My solution was to use one that had been set slightly apart from the others on another floor in the building. Fortunately most offices have self-contained loos and you’ll find those slightly longer visiting times are offset by only needing to go once during the working day (some may need two visits).

Six months later I am living a simpler, easier and more controlled life. In the day I am a buoyant, far more sociable and, I like to think, effective human-being. Just as Simon said I would be. I also sleep better as I don’t have to get up in the night to go to the lavatory.

My advice is this: if you’ve ever had any qualms about using a catheter, persevere or make an appointment with your local pouch specialist and ask him or her to show you how it works. You may be reluctant at first but once you’ve succeeded, you’ll never look back.
As for me, I’ll always be grateful to Simon and Beccy for converting a once bashful patient into a Catheter Convert.

If you’ve any concerns or want to discuss using a catheter, please contact me on 07939 110842 or cbrowne@brownemedia.co.uk I’ll be happy to talk to you. Or for a more professional opinion speak to your hospital’s stomacare department.

You can read all about Medena catheters in Simon McLaughlin’s exclusive survey in a recent issue of Roar!

A version of this article first appeared in ROAR! If you would like to read other articles like this, why not become a member of the Red Lion Pouch Support group? You will receive printed copy of ROAR! twice a year and have online access to archive ROAR! editions going all the way back to issue number 1, published in 1994.

See pouchsupport.org/join for further information.

Pouch irrigation and catheterisation demystified

Pouch irrigation and catheterisation demystified

Perspective

Claire’s Story

My Medena Catheter Conversion

My Medena Catheter Conversion

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