Rectal Irrigation Procedure

Children born with Hirschsprung disease often suffer from a condition called enterocolitis. Enterocolitis is the medical name for inflammation or infection in the lower intestine or colon. Enterocolitis can cause your child to have a fever, bloated belly, fewer poops or stools, explosive diarrhea, foul smelling stool, and sometimes vomiting. Enterocolitis can happen when stool stays in the colon too long, causing bacteria to grow. The bacteria make a poison called a toxin. The best way to treat enterocolitis is by using fluids to flush and clear the colon of these toxins. This process is called rectal irrigation. To perform a rectal irrigation, you will need the following supplies. Two small basins. 160 mL catheter tip syringe. 122 French silicone or red rubber catheter marked it 4 to 6 inches. Water soluble lubricant. Warmed normal saline and a tape measure. To begin, warm the normal saline. We recommend placing the bottle of saline in a sink or bowl of warm water. After a few minutes, test the temperature of the saline on the inside of your wrist to make sure it's body temperature. This is like warming a baby bottle. Next, pour the warm saline into one of the basins. Use the catheter tipped syringe to draw up 20 mL of warm saline. Position your child so they are laying on their back with their knees bent to their chest. If they are bigger, position them with knees bent and their feet flat on a surface. You may need another person to help hold their legs in this position. Place the empty basin next to your child. Put some lubricant on the top 2 inches of the tip of the catheter and insert it into your child's rectum. Gently push the catheter so it follows the curves of the colon, inserting the catheter about 4 to 6 inches. Pause to allow any gas or stool to drain out of the catheter and into the empty basin. Connect the syringe to the catheter and inject the 20 mL of warm saline. Then disconnect the syringe and allow stool and gas to drain into the empty basin. Move the catheter in about 1 inch further and repeat the process. Continue this process until the returned fluid is clear. Do not advance the catheter past the bottom of the catheter. You must pause between each injection to allow fluid to drain from the catheter into the basin. If the amount of saline injected into the colon is more than the amount of fluid that is coming out, then there is extra fluid in the colon. To drain the extra fluid, try moving the catheter in and out using a twisting motion. This will help drain pockets of saline, gas, and stool. If the fluid does not come out, the catheter may be clogged. If you think the catheter is clogged, pull it out of the rectum and flush it with saline into the basin before putting it back into your child's rectum. If fluid remains in the colon, attach the syringe to the catheter and very gently pull back on the syringe to draw out the fluid. Stop if you feel resistance. It is important to keep track of the amount of saline injected into the rectum and the amount of fluid that comes out in a good rectal irrigation. The amount of fluid that comes out is more than the amount injected. Once the drained fluid is clear, remove the catheter from the rectum. Wash all supplies with soap and warm water and allow to air dry. These supplies are reusable. For more information, please call the Colorectal Center at Primary Children's Hospital.