In this article, we are going to cover what is bowel irrigation or TAI and digital evacuation. People with Spina Bifida have bowel dysfunction, which causes this issue. The procedures below often manage conditions like chronic constipation, faecal incontinence, and neurogenic bowel.
What is Bowel Irrigation Or TAI?
For most people, emptying the bowel is straightforward. However, it doesn’t work smoothly for people with Spina bifida. If you experience constipation, bowel leakage, or spend too much time on the toilet, bowel irrigation might be one of the suitable treatment options. This procedure varies from person to person and country to country depending upon, what type of tools are available.
Typically, the procedure involves inserting a rectal catheter and flushing the bowel with lukewarm water. Insert a rectal catheter with a balloon or a cone catheter (without a balloon) into the rectum. Inflate the balloon to hold the catheter in place while instilling the water. After instilling the water, remove the catheter, and empty the bowel. The water softens the stool and stimulates peristatic movements, which help the stool move towards the rectum for evacuation.
If a person has had the MACE procedure, they can administer enemas or irrigation at the beginning of the colon instead of through the rectum at the end. The Malone Antegrade Continence Enema (MACE) procedure, also known as an appendicostomy, is a surgical procedure that creates a passageway from the abdomen to the colon. We will talk about MACE procedure in detail in a different article. MACE has some downsides which most healthservice providers don’t mention.
Bowel irrigation, also known as rectal irrigation or trans-anal irrigation (TAI), empties the lower bowel. It is a treatment option when other methods like medications, dietary changes, and fluid adjustments, have not been effective.
How Does Bowel Irrigation Work?
Insert a rectal catheter with a balloon or a cone catheter (without a balloon) into the rectum. Inflate the balloon in the rectum to hold the catheter in place while instilling the water. This initiates the bowel movements, that moves the stool toward the rectum. After instilling the water and removing the catheter, the bowel can be emptied. Perform the procedure on the toilet, and you can do your bowel irrigation at home.
Regularly performing this procedure will effectively empty your bowel, keeping it clear until the next irrigation. This allows you to choose the time and place for bowel emptying, giving you greater control and convenience.
What is Digital Evacuation?
Another effective method for individuals with severe constipation and neurogenic bowel is digital evacuation. Also known as digital disimpaction, this procedure involves using a finger, with or without gloves and lubrication, to manually remove stool from the rectum. This method is very helpful, especially for severe constipation, and can be used with or without bowel irrigation. It’s important to learn this procedure from a healthcare professional or someone experienced in it. Most people we know prefer using the middle finger for digital evacuation. The best part about this procedure is that you don’t need any tools—just some water or lubricant. You can do it anywhere, in any setting. We will discuss this in detail in another article.
Some Advantages of Digital Evacuation Compared to Bowel Irrigation are:
- Quick Relief: Provides immediate relief from severe constipation and rectal discomfort.
- No Equipment Needed: Requires only a gloved, lubricated finger, making it simple and accessible.
- Effective for Impaction: Particularly useful for removing hard, impacted stool that other methods can’t address.
- Minimal Preparation: Does not require extensive preparation or setup.
- Immediate Results: Offers quick results, often within minutes.
- Useful in Emergencies: Can be performed in urgent situations where other methods might not be feasible
What are the Benefits of Bowel Irrigation and Digital Evacuation?
Here are some benefits of a regular bowel irrigation routine:
- Prevents Constipation: Helps maintain regular bowel movements and prevents constipation.
- Reduces Bowel Leakage: Minimizes the risk of accidental bowel leakage.
- Improves Comfort: Reduces discomfort and bloating associated with irregular bowel movements.
- Enhances Quality of Life: Provides greater control over bowel management, improving overall quality of life.
- Saves Time: Reduces the time spent on the toilet, making daily routines more efficient.
- Promotes Independence: Allows individuals to manage their bowel health independently.
- Reduces Medication Dependence: Decreases the need for laxatives and other bowel-related medications.
- Supports Social Activities: Enables participation in social activities without the worry of bowel issues.
Takeaway
Constipation is a blessing in disguise for people with Spina Bifida. Loose or semi-loose, or “right consistency” stool can result in leakage and accidents. Constipated stool (Type 2 in the image) doesn’t leak and can be removed without causing a mess. People with Spina Bifida should not fight constipation and maintain it in a way that is easy to handle.
Please Note
The information provided on our website is not intended as medical advice for any individual. Since specific cases may differ from the general information presented, SASHA recommends consulting a qualified medical or other professional for personalized advice.
FAQ
Which is better, bowl irrigation or digital evacuation?
In our opinion, digital evacuation is better and faster. In digital evacuation there is no need for any equipment, can be done anywhere and in any position.
Is constipation good for people with Spina Bifida?
Yes, it is a blessing in disguise. Loose or semi-loose, or “right consistency” stool can result in leakage and accidents. Constipated stool (Type 2 in the image) doesn’t leak and can be removed without causing a mess.
How much fiber should I take?
It depends on your age and gender. People with SB should find and stick to the right intake that keeps the constipation but in a manageable way. Fibre also makes your stool bulky and lubricated, thus easy to remove in big chunks.
What is a bowel irrigation?
Bowel irrigation is when water is introduced into the bowel via the rectum or through the catheter into your lower bowel. The water is expelled into the toilet flushing out any faecal matter with it thereby emptying your bowels.
Can I irrigate my bowels at home daily?
Yes, you can.
How long does bowel irrigation take?
The process takes approximately 20-35 minutes.
Is bowel irrigation the same as an enema?
A colon cleanse is not the same thing as an enema. With an enema, you use liquid to clean out your rectum and the lower part of your colon.
How painful is bowel irrigation?
Bowel irrigation is a safe and gentle procedure. However, some people may experience side effects which can include mild abdominal cramping, bloating, or feeling full, and pain in the rectal area
What is a digital evacuation?
Removing stool with the aid of your finger is called a digital evacuation.
How painful is digital evacuation?
Not painful at all.
Is it possible to hurt yourself during digital evacuation?
Not really. However, you should not have long fingernails and be patient in the process.
How long does digital evacuation take?
The process takes approximately 5-7 minutes.
How many times a day do I need to digitally evacuate?
Usually twice a day. It depends on how much you are eating and what you are eating.
How to move your finger for the best digital evacuation experience?
Move your finger back and forth in a side-to-side scissor motion to break up the hard stool. Next, bend your finger slightly and move it in a circular motion inside the rectum to help remove the stool.
Which hand and which finger should I use for Digital evacuation?
You should use the middle finger of your strongest hand. The middle finger is the longest and has the highest reach. We suggest you train the right finger and hand, right from the beginning as it is difficult to switch later.
What is the best position for the digital evacuation?
You can either sit on the toilet seat and remove or you can half squat (if your legs support it) and remove it, or you can lie down sideways, fold your legs to your stomach remove it and put it in a container. Call us!
Do I need to use gloves during digital evacuation?
It’s a personal choice. We recommend that you don’t use gloves. Please note that a lot of SB people have a latex allergy. You can keep rinsing your hands with the health faucet’s water and remove piece by piece. Also, with gloves, you can’t use water to wet (lubricate) and clean your hand/finger. You will have to use Lidocaine Jelly or some kind of water-based lube.
Do I need to use Lidocaine Jelly or any water-based lube if I am not using gloves?
No. You can use water to clean and lubricate your finger every time to re-enter your rectum.
Will using just bare hands and water (no gloves) increase my chances of UTI?
No. Always remember to self-catheterise first and after that do digital evacuation if you have to do both. If you are doing just digital evacuation, you need to wash your hands properly post-evacuation.
How do I keep my buttocks clean post evacuations? Do I need to bathe every time after?
Wash with health faucet or bidet water and dry with toilet paper or a cloth. While bathing, wash your buttocks with soap or intimate wash. Women in particular should maintain the best butt hygiene as the distance between vulva and rectum is less.
Does removing buttocks (midline and perineum) hair in teenagers and adults who practice bowel irrigation or digital evacuation, beneficial?
Yes, maintaining hair-free areas can improve hygiene and help prevent urinary tract infections (UTIs). Maintaining hygiene becomes particularly challenging for women and those with frequent accidents due to bowel incontinence.
Does bowel irrigation or digital evacuation help with farts (gas)?
A clean and empty bowel can help with gas. If you have painful gas and bloating, it may be because it is trapped behind stool.
Can people with Spina Bifida control farts (gas)? And why?
No. A lot of people with Spina Bifida, especially with myelomeningocele, can’t control farts because their anal tone is missing. The anal sphincter is incapable of holding gas at will. Kegels and pelvic floor exercises can help with this issue.
Can bowel problems affect sex life?
Yes. Most people with bowel incontinence are afraid of accidents during the act.
Can sex cause bowel movement or bowel leakage?
Yes. Orgasm/Ejaculation can trigger bowel movement, especially, in men with Spina Bifida. Accidents may occur if the stool is not constipated and if the anal tone is missing. The bowel movement post-ejaculation, in men, seems to subside when one has sex regularly for a long period.
How can I avoid accidents during sex?
Empty your bowel properly, beforehand. Further, you can masturbate before you meet your lover. Masturbation will trigger the bowel movement and you can digitally remove the descended stool. Stay constipated.
Why do a lot of people with Spina Bifida get diarrhoea during a course of antibiotics?
This is known as antibiotic-induced diarrhoea or Antibiotic-associated diarrhoea (ASD). We understand how uncomfortable diarrhoea can be for someone who doesn’t have an anal tone and can’t hold it. Most people don’t even have enough reaction time to reach the toilet.
How can I avoid antibiotic-induced diarrhoea or Antibiotic-associated diarrhoea (ASD)?
You should always let your doctor know which antibiotics trigger this and ask for the ones which do not. For example, nitrofurantoin and fluoroquinolones (norfloxacin, levofloxacin, and ciprofloxacin) are some examples that, when taken orally don’t trigger ASD. Augmentin which is commonly prescribed after a urine culture, is a big culprit and will trigger ASD. You should also know that probiotics with antibiotics don’t help either. If you have easy access to nursing staff, taking injectable antibiotics instead of oral will help. We at Sasha encourage individuals or family members to learn how to give injections and put an IV (canula) line. This way help is always there and it also saves money.
About the Author
Raul/DJ Vivek
Meet Vivek Bharadwaj, a remarkable individual who has defied the odds and soared to new heights despite living with Spina Bifida. As the founder of the Sasha Foundation, Vivek tirelessly advocates for others facing similar challenges. His unwavering commitment to support, awareness, and empowerment had made a lasting impact on the Spina Bifida community.
