Before performing any of the instructed steps in this video, always check with our team or your child’s pediatrician for safety.
If you’re watching this video, it’s because rectal irrigations have been prescribed by our care team or your child’s primary care provider to help your child empty their colon of stool and gas. Rectal irrigations flush a safe liquid through the colon to help clean stool out and to prevent infection. The goal of this video is to teach you to perform rectal irrigations at home with your child. For more information on this topic or to access other educational videos and resources, please visit our website at https://childrensnational.org/departments/colorectal
Type: video · 5 min · posted 2023-06-16 Canonical: https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744 ## Chapters - [0:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=0) Introduction and Clinical Rationale - [1:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=90) Supplies and Preparation - [2:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=150) Irrigation Procedure - [4:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=270) Troubleshooting - [5:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=300) Warning Signs and Resources ## Statements - "Children with Hirschsprung disease or functional constipation have colons that may not move stool through the body as quickly as it should, called dysmotility." — Emily Rice (clinical) [0:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=0) - "When stool sits in the colon for too long, it can cause bacteria to grow and can lead to enterocolitis, an inflammation of the colon." — Emily Rice (clinical) [0:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=0) - "Rectal irrigations help prevent and treat enterocolitis by putting saline into the colon to clean stool out and prevent infection." — Emily Rice (clinical) [0:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=0) - "If a child has a history of Hirschsprung disease and shows signs of enterocolitis or dehydration, an irrigation should be performed and the medical team contacted immediately." — Emily Rice (guideline) [0:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=0) - "A 24-French silicone Foley catheter is used for rectal irrigations; for children under one year of age, a 20-French catheter is used." — Emily Rice (clinical) [1:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=90) - "The child should be positioned on their back with knees bent and pulled up towards the chest to visualize the anus and allow stool and gas to exit." — Emily Rice (clinical) [2:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=150) - "The Foley catheter should be gently inserted into the rectum about 4-6 inches." — Emily Rice (clinical) [2:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=150) - "20 milliliters of saline should be instilled with each flush using the large catheter-tipped syringe." — Emily Rice (clinical) [2:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=150) - "It is important to wait between each flush for fluid to drain and to ensure 20 milliliters is returned before repeating." — Emily Rice (clinical) [2:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=150) - "Irrigation should continue until the fluid draining from the catheter is clear." — Emily Rice (clinical) [2:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=150) - "The catheter should not be inserted all the way to the end and should not be forced; it will easily follow the pathway or curve of the colon when gently advanced." — Emily Rice (clinical) [2:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=150) - "If saline is pushed in but no water or stool comes back out, pull the catheter out a little bit then gently push it back in." — Emily Rice (clinical) [4:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=270) - "If no saline or stool returns with irrigation, check the catheter for blockage such as food or thick stool, as stool can block the tiny holes at the catheter tip." — Emily Rice (clinical) [4:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=270) - "If there is still no return after troubleshooting, contact the medical team or pediatrician." — Emily Rice (guideline) [4:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=270) - "Signs of enterocolitis include fever, a swollen or large belly, foul-smelling stool, or no stool out in 24 hours." — Emily Rice (clinical) [5:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=300) - "Signs of dehydration include not urinating as much as normal, fewer wet diapers, dry or sticky mouth, few or no tears when crying, sunken eyes, cool skin, irritability, dizziness, or being more tired than usual." — Emily Rice (clinical) [5:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=300) - "If a child develops signs of enterocolitis or dehydration, the medical team or pediatrician should be contacted immediately." — Emily Rice (guideline) [5:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=300) ## Transcript Hello, I'm Emily Rice and I'm a nurse with the Division of Colorectal and Pelvic Reconstruction at Children's National Hospital. I'm here today to teach you about administering rectal irrigations at home. Before performing an irrigation on your child, always check with our team or your child's pediatrician for safety. 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. This is called dysmotility. When stool sits in the colon for too long, it can cause bacteria to grow and can lead to an illness called enterocolitis, which is an inflammation of the colon. Rectal irrigations help you keep your child healthy and safe by preventing and treating enterocolitis. Irrigations put salt water, called saline, into the colon to help clean the stool out and prevent infection. If your child has a history of Hirschsprung disease and is showing signs of enterocolitis or dehydration, you should perform an irrigation. You should also immediately contact our team or your pediatrician. The goal of this video is to teach you how to perform rectal irrigations at home with your child. You will need several supplies to perform rectal irrigations. These supplies should have been given to you prior to your discharge from the hospital. They include two bowls, a 24-french silicone foley catheter. If your child is not yet one year of age or is under one, you will use a 20-french silicone catheter, a large catheter-tipped syringe, usually 50-60 milliliters, water-soluble lubricant gel, and saline and saline or salt water. First, pour saline into one of the bowls. Then, using the large catheter-tipped syringe, pull up 20 milliliters of saline. Use a pea-sized amount of your water-soluble lubricant jelly on the tip of the Foley catheter. Position your child on their back with their knees bent and pulled up towards their chest. This will allow you to visualize your child's anus and allow stool and gas to exit the colon. You may want someone to help you hold your child in the proper position. Gently insert the Foley catheter into the rectum about 4-6 inches. Place the other end of the catheter into an empty bowl so it can drain. Allow any stool or gas to empty. Move the catheter into the rectum a bit more to allow any other pockets of stool or gas to further empty. Slowly turn and move the catheter back and forth in the rectum. This may help find pockets of stool that are stuck in the colon. Next, take your large catheter-tipped syringe and place it into the open end of the Foley catheter. Slowly push on the plunger to make the saline solution flow through the catheter and into the rectum. Hold the catheter at the same level of the anus so it does not fall out. Don't tug on it. Remove the syringe from the end of the catheter and allow the saline and any stool to run back into the empty bowl. It is important to wait between each flush for fluid to drain out of the rectum. Make sure you are getting 20 milliliters back from each flush before repeating. You can continue irrigating until the fluid draining from the catheter is clear. Each time, push the catheter a few inches further. Twist or spin. Do not insert the Foley all the way to the end of the catheter. And do not force the catheter. When you gently advance it, the catheter will easily follow the pathway or curve of the colon. Once the water is draining clear, the catheter can be held in place for a few extra minutes to make sure all stool, gas, and saline has come out. Some things to remember. If you are pushing the saline in and you are not getting water or stool back out, pull the catheter out a little bit, then gently push the catheter back in. If you do not get any saline or stool back with irrigation, check the catheter for anything blocking it, like food or thick stool. Sometimes you have to clean it out several times during the irrigation, as stool will block the tiny holes at the tip of the catheter. Massage the child's belly or have them change positions. If you still do not get return, contact our team or your pediatrician. Some important things you should know. If your child develops signs of enterocolitis or dehydration, it is a reason to be concerned. Call our team or your pediatrician immediately. Signs of enterocolitis include fever, a swollen or large belly, foul-smelling stool, or no stool out in 24 hours. The signs of dehydration include not peeing or urinating as much as normal, fewer wet diapers than usual, a dry or sticky mouth, few or no tears when crying, eyes that look sunken, cool skin, irritability, dizziness, or being more tired than usual. If you want more information, please visit the colorectal program's website. We have multiple videos and printed resources to help you care for your child. And don't forget, always check with your child's pediatrician or our team when caring for your child's medical needs. W3 W2 W2 --- Not medical advice · citation policy: https://library.globalcastmd.com/ai