Daily Enema

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Daily Enema

Postby CRP » Sun Jun 24, 2007 4:26 pm

The long term effects on bowel function of low rectal cancer survivors is often the least discussed topic before treatment and the biggest challenges after treatment. Everyone in this Club who has had low or very low rectal cancer knows the impact that the removal of some or most of the rectum has on their quality of life.

I am an ultra low rectal cancer survivor (cut line 2 cm above anal verge, Stage II, 1997, LAR, no pouch, no adjunct treatment). The LAR destroyed my normal bowel function. There was the normal multiple urges, inability to evacuate, incontinence, extreme urgency etc. Through desperation and the lack of concern on the part of my doctors, I began to experiment with a daily large volume tap water enema while taking my morning shower. I use a balloon catheter to allow me to shower without having to hold the tip. This approach truly works. Other than a 15 minute per day commitment to bowel management I live a normal life.

This approach is medically approved by my doctors and research. Follow the link to see a summary article on the use of daily enema. http://www.ncbi.nlm.nih.gov/sites/entre ... xed=google

All that is necessary to eliminate the consequences of the treatment for low rectal cancer is a commitment to try the unconventional, the proper equipment and technique.

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Postby Discoclub » Sun Jun 24, 2007 5:05 pm

This is interesting. My mother has followed a similar regimen for over 14 years now. Her regimen has been to wait until day three then evacuate by enema. Seems to work for her as long as she remembers the third day and plans for it.

Your approach seems mor organized, I hope it works well for you. My cancer is also quite low. 7cm from verge.

Do you plan this to be your regimen for the rest of your life? Or, are you attempting to retrain your body back to normal function? You seem to be someone who thinks outside the normal "Box", so I am curious do you think the body is a self healing organism that can retrain and eventually develop the peristaltic "pushing" function again once the tissues have healed and become strong enough to not tear apart?.

Please post or send email with your thoughts. I am very interested since both my mother and I have similar low rectal cancers.

Healthy healing to you.


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Postby CRP » Sun Jun 24, 2007 6:10 pm

The damage caused by the removal of the rectum is permanent. This is the result of the loss of the rectal reservoir and the powerful rectal muscles that normally empty the entire contents of the rectum when you go to the toilet. I have used the daily enema regime for 10 years. There have been times when I have neglected the enema and the loss of bowel function returns immediately.

The peristaltic action that you mention is the systematic involuntary contractions of the muscles that surround the colon that moves stool along the colon. The enemas do not affect this action.

I do an enema daily because it is more efficient. Since the colon is basically empty of stool, a 2 quart enema bag will empty in only about 5 minutes. There is no cramping because unlike taking an enema for constipation, there is no stool to block the flow. The colon can be emptied in about 10 minutes because there is no blockage of stool when you do a daily enema.

Take a look at this web site. It deal with incontinences for children but the science is the same for an adult.

For those who want to think “outside of the box” the daily enema can change the life of a low rectal cancer survivor forever. It truly eliminates the consequences of the rectal cancer treatment.

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Postby Discoclub » Mon Jun 25, 2007 1:40 am

Thank you for your response. Your answer is the same my mother tells me. I wish for you a long healthy life.

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Postby CRP » Mon Jun 25, 2007 10:01 am

The use of daily enemas is the least understood and seldom discussed option that the medical community gives low rectal cancer survivors.

One of the most detailed and often referenced research paper ever done on the issue of rectal cancer is titled “Methods and Results of Sphincter-Preserving Surgery for Rectal Cancer” by McNamara and Parc. The paper is quite blunt about the consequences of the surgery but makes the this simple statement … “Although evacuatory difficulties are inconvenient, they are easily addressed by the use of enemas, and patients generally remain asymptomatic in the intervals between evacuation.”

You can follow the link to see the full text of the article.

Don’t expect your doctor to recommend daily enemas. In our society even the mentioning of the word enemas is embarrassing. The medical community is much more comfortable in recommending pharmaceutical options to deal with the symptoms.

What is missing in the discussion is a description of how to do an enema in a manner that is the most efficient and can be incorporated into your daily life. With the correct equipment and proper technique you can do an enema in about 15 minutes. The biggest challenge is having the commitment to try this technique and a supporting spouse. You don’t have to be a victim of your rectal cancer treatment if you are willing to try the nonconventional approach of a daily enema.

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daily enema

Postby Sunny » Mon Jun 25, 2007 12:02 pm

I am DiscoClub's mom. He sent your daily enema article to me. I'm certainly willing to try a different approach to evacuation than what I have "invented" for myself, which is a diverter valve attached to my faucet with a tube than reaches to the toilet; allowing the water to flow and flush the feces. Takes about an hour. I drink a coke in gulps while doing this. One of my docs showed me that the carbonation helps to build "push" pressure (ok.. gas). The resection point is very narrow due to scar tissue.

So, I'm very curious about what you have described. I'm not sure what a balloon catheter is (can figure it basically) or where to get one. Is your water source from a hot water bottle or what? Do you have an article that is more descriptive of how to set up?


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Postby Discoclub » Mon Jun 25, 2007 1:42 pm

Thank you for the detailed email.

i am going to ask a couple questions here, so all may learn.

You refer to a "Balloon catheter" Are you referring to a "Foley Catheter"? If so, can you tell me what size? 14fr? 16fr? I am not sure what the "French" size determines. Is this the overall inside or outside diameter?

Also, what do you use to inflate the foley? Do you use the inflation bulb from a standard blood presure cuff? OR do you use a syringe and water like a hospital would use?

This simple advice may change my mom's life. Now finally she may have a simple way to travel after 14 years of her other way.

Thank You for posting.

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Postby CRP » Mon Jun 25, 2007 2:59 pm

A rectal retention catheter is a flexible tubing that has a 250 cc balloon at the end. Once the deflated retention catheter is inserted into the anus it is inflated by an inflator bulb that is like a blood pressure bulb. Once inflated the catheter will not fall out of the anus as water flows into the colon. The benefit of this device is that you can do an enema while standing and not have to hold the nozzle to keep it from falling out.

Although research articles, such as that posted above, show that the use of a daily enema is successful 93% of the time in reducing or eliminating the documented consequences of low rectal cancer treatment and that the leading researcher endorses the use daily enemas, it is unlikely that the medical community will ever embrace this concept. Doctors are uncomfortable in even discussing enemas with their patients, are most likely unaware of this option and have no clue on how to educate survivors about how to do an enema in an efficient manner that can be incorporated into a normal life style.

This board is probably the most read colon cancer site. Unless more members express an interest and start a dialog about this approach, the thread will die a natural death. What do you think?

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Postby Discoclub » Wed Jun 27, 2007 12:09 pm

Well, the board is "ColonClub" maybe there are not so many REctal cancer patients here.

My mom was excited to hear from another survivor who has experienced the same type of situation. Oddly, she had to develop her technique on her own. Even her onco could tell her what to do about this situation.

thank you again for being bold enough to post this helpful info.

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Postby eitter » Wed Jun 27, 2007 5:13 pm

I have/had rectal cancer.

It is my personal belief that rectal and colon cancer go hand n hand.
DX 05/06 Rectal
6 Weeks radiation with 5FU
LAR 10/06 Stage III
Temp Ileo, reversal failed in 05/07 after 1m in hospital came out with a permanent colostomy

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Postby Rels » Sat Jul 14, 2007 3:18 am

Hi it's interesting to hear from others who have had rectal ca.
I had an ultra low anterior rescetion with jpouch for low rectal ca in April 07. 10 days ago I had the ileostomy take down and things have been a bit chaotic since then mostly with leakage with bowel gas, infact I haven't had a decent BM for 5 days except for sticky bits and pieces when passing gas. I hope things get better. I know someone who had the same surgery 5 years ago by the same surgeon and has irrigated every 2nd day for the past 4 years, (that would be the same as using an enema). The surgeon suggested the procedure to her and the stoma nurse showed her how to do it. I think most stoma nurses would be able to assist with the procedure. I am prepared to irrigate if it gets to that.

Thanks for the info its been very helpful.

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Re: Daily Enema

Postby CRP » Fri Jun 15, 2012 5:51 pm

The technique and equipment is critical if the daily enema can be done safely in an efficient way. You cannot succeed without either. The equipment is not the same as you find in the big box stores. The rigid tip of the enema or douch kit is dangerous to use on a daily basis. The only safe tip is called a “rectal catheter”. It is simply a collapsed 1” diameter rubber balloon that is inserted into your anus after it is well lubricated. On inserted, you squeeze a little bulb to inflate the balloon just inside the end of the anus. The balloon acts as a plug so that you don’t have to hold the tip in, and relax your anal muscles and it can’t puncture the rectal wall. The catheter that I use cost $120 but last for several years.

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Re: Daily Enema

Postby Jachut » Fri Jun 15, 2012 6:32 pm

What really concenrs me is the lack of concern by doctors and surgeons for quality of life after an ileostomy reversal.

If a daily enema will help me with mny problem of obstructed defecation, I will try it. But I have to admit, just like the laxatives I am currently using, having a complicated toilet routine that I have to plan for and allocate significant time to is NOT an entirely acceptable outcome to me. I really needed to do my whole elimination routine last night, but I had kids to run about to their various events. What to do? Take the lactulose anyway and suffer the driving and in and out of the house with my teeth gritted? Or not take it until I was home for the night (11pm) and just sit up all night? I cant do it in the daytime because the grumbling, gas and upset tummy do tend to continue for a while and I generally need a night's sleep to recover and feel good to go for two more days. An enema is something I'm coming closer and closer to trying. Regardless of the fact that I "cope" this really affects my lifestyle - for example, I will definitely not be able to attend my grade's school camp later this year - camping in a national park. There is no way on earth I can take my routine into that sort of situation. I'm on a 12 month contract, that'st he way teaching works in Australia. I am going to have to inform my school that I wont be going. That'll make me popular. Bet I'm on a 12 month contract somewhere else next year!

But that's not the point. I just dont understand WHY the whole focus is on getting us bagless with no other outcome considered successfu. Why even bother? Why do our specialists not accept that a permanent ostomy IS a valid choice in this situation?

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Re: Daily Enema

Postby CRP » Sat Jun 16, 2012 8:40 am

The “’daily enema” is a technique that simply replaces the normal bowel function. Because you keep eating, there is somewhat of a constant stream of initially semi-liquid stool entering the colon at the cecum. As it travel through the colon water is absorbed by the colon walls and the peristaltic action of the colon clumps up the now semi-solid stool. The problem comes when the clumps reach the missing rectum. There is no storage space so it pushes directly up against the anal sensing nerves. This is the urge you feel. You can’t “push” out the full length of the stool string into the toilet because you have lost many of your rectal muscles. You can be back on the toilet many times before the stool string is passed.
The daily enema is a total substitute for normal bowel functions. The daily enema can be used the rest of your life with no long term bowel functional problems. Your goal is not to simply empty the rectum, which does give temporary relief. The goal is to flush out the stool in all of the descending and most of the transverse colon. Most people need two quarts to flush out this much of the colon. One quart does not go high enough in the colon to give full 24 hour relief. When you flush the colon with two quarts of plain tap every day, there are no large hard clumps that are common with constipation or when you take medication that actually slows down your transit time. Water will flow into a nearly empty colon amazingly fast (less than 2 minutes for me) after you do the daily enema for an extended period.

With experience, the entire process from start to end can be done in less than 20 minutes. After the bag is empty you can immediately relax the anus and let the water flow out. Water from an enema empties in waves. After the first quick group of large waves, you can intermittently continue putting on makeup or shaving as long as you can sit back on the toilet quickly when needed. There is no pain during an enema if your lower colon is being regularly emptied. Enema pains are cramping that occurs when you try to force water around large clumps of stool that are blocking the flow of water. You simply have to get used to the strange feeling of a lot of water flushing from your bowel. It is can be messy. I is your responsibility to leave a leave a clean bathroom. It can become as routine as brushing your teeth.


Re: Daily Enema

Postby prc » Thu Oct 11, 2012 12:20 am

It looks like it has been a while since anyone has posted here - so I hope crp is still around to answer questions. I am also a low rectal cancer survivor and have been taking daily enemas for one year. Four days ago I decided to take a month off to see if anything is working on its own. I've not had a bm since... so looks like I'm back to it tomorrow - I don't want a month of constipation. The bowel just won't push things out.
My question for crp is where do you buy your materials - the soft bulb/insert? I've just been using the drug store bag/insert.

I've heard about your technique, but a little scared to use it. I asked my docs about it last year, and they are afraid I might damage my colon because of the water being trapped by the bulb - as in perhaps forcing an explosion inside? Any comment about that?

Thanks for any help you can give me.

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