How to Administer a Rectal Irrigation at Home

Emily Rice is a nurse with the Division of Colorectal and Pelvic Reconstruction at Children's National Hospital.

Rectal irrigations can help a child empty their colon of stool and gas.

Children who suffer from Hirschsprung disease or functional constipation have colons that may not move stool through the body as quickly as it should, a condition called dysmotility.

When stool sits in the colon for too long, it can cause bacteria to grow and can lead to enterocolitis, which is an inflammation of the colon.

Rectal irrigations help keep a child healthy and safe by preventing and treating enterocolitis.

Irrigations put salt water (saline) into the colon to help clean the stool out and prevent infection.

If a child has a history of Hirschsprung disease and is showing signs of enterocolitis or dehydration, caregivers should perform an irrigation and immediately contact the medical team or pediatrician.

A 24-french silicone Foley catheter is used for rectal irrigations in children one year of age or older.

A 20-french silicone catheter is used for children under one year of age.

The irrigation procedure uses 20 milliliters of saline per flush.

The child should be positioned on their back with knees bent and pulled up towards their chest to visualize the anus and allow stool and gas to exit the colon.

The Foley catheter should be gently inserted into the rectum about 4-6 inches.

Slowly turning and moving the catheter back and forth in the rectum may help find pockets of stool that are stuck in the colon.

It is important to wait between each flush for fluid to drain out of the rectum and to ensure 20 milliliters is returned from each flush before repeating.

Irrigation can continue until the fluid draining from the catheter is clear.

The catheter should not be inserted all the way to the end and should not be forced; when gently advanced, it will easily follow the pathway or curve of the colon.

If saline is pushed in but no water or stool comes back out, the catheter should be pulled out a little bit then gently pushed back in.

If no saline or stool returns with irrigation, check the catheter for blockage by food or thick stool, as stool can block the tiny holes at the tip of the catheter.

Massaging the child's belly or having them change positions may help if there is no return of fluid.

If there is still no return after troubleshooting, caregivers should contact the medical team or pediatrician.

If a child develops signs of enterocolitis or dehydration, caregivers should call the medical team or pediatrician immediately.

Signs of enterocolitis include fever, a swollen or large belly, foul-smelling stool, or no stool output in 24 hours.

Signs of dehydration include not urinating as much as normal, fewer wet diapers than usual, a dry or sticky mouth, few or no tears when crying, sunken eyes, cool skin, irritability, dizziness, or being more tired than usual.