Anyone use warm enemas to flush pouch?

Hi, Jeane.  I would think your GI is right.  As long as you are not hurting anything it may be just fine.  While I don't have much of a need now, I used to use my coco bidet to do some flushing on occasion.   Hope it helps!

Thank you for the response knklhead. . 

Hi Jeane,

A while back, there was a thread I believe in the Pouchitis forum about this very topic, particularly regarding using tap water enemas to avoid fecal stasis (or incomplete emptying of the pouch), which some physicians believe may cause or at least contribute to pouchitis. That thread got a lot of replies, and based on the number of replies, it would appear that using tap water enemas once a day is not an uncommon recommendation from several GIs and/or surgeons.   I would agree with knklhead that this should be fine, as long as your GI approves, you're comfortable doing it, and there is no pain. I would think, in fact, that using enemas will help in softening the stool and making it easier to pass around your stricture, and will also help you avoid straining. So again, I say as long as there is no pain and you are comfortable administering the enemas, go for it!  

Thank you Spooky. I appreciate your comments.  

FYI-You can get a bidet attachment for your toilet wig a enema or turbo function (I have Biobidet i3000-$200-easy hookup, no electricity needed) that makes it much easier than doing a traditional enema and avoid any irritation in the canal due to insertion of the enema applicator.

I like my bidet a lot, but I wouldn't consider it a substitute for an enema, regardless of how the button is labeled. The water force required to get into the pouch is considerably rougher (IMO) than a properly lubricated, gently inserted enema, and the water from a bidet won't reach the pouch's more remote areas. I'm not a big fan of enemas for pouch emptying, except as a last resort, but if you need an enema I'd recommend doing it properly.

The only time I make use of an enema is right before having a scope by my doctor.  Even then, I only use warm water even though I use the bottle which comes with a fleet enema.  I just empty the solution which comes with the enema and fill it with warm water.  I've had my J-pouch for about 15 years.

I'm still struggling with pouchitis.  Since the structure is tight, inserting the enema is not pleasant. This bout of pouchitis is the worst yet. Lots of left sided abdominal pain, urgency, increased trips and cramps and discomfort.  5 days on 1000 mg Cipro not cutting it.  Seeing GI next week and may need to consider enticort. Hanging on to pouch by a thread even w diet change , Xanax for anxiety from all of this and extra vsl3 ds. So frustrating.  

I have used enema before endoscopic exam. It works well even though it isn't comfortable at all.

Jeane, I may be misunderstanding you, but I don't think Cipro will provide any benefit for a stricture. I hope you can get it dilated soon. In any case, I certainly agree that it's easier to get water past a tight stricture than trying to push an enema nozzle through. 

Hi Scott,

I had the stricture dilated last week. I am passing stool much more easily, but I have some really bad pouchitis going on that is not responding very well to Cipro.  Dr. Remzi basically told me my pouch is burnt out and I have mechanical/disease  related issues and he is recommending a 6 month ostomy before trying a pouch redo if I prefer. I am seeing GI in next week to see if I can ramp up some other meds to get the pouchitis better controlled.  If I divert to ostomy, it is highly unlikely I will try the pouch again as my five years with it have been nothing but troublesome. 

Thank you for the responses, I have been pretty down about this whole situation. 

Not sure if this is pertinent or not but as a k pouch we are taught to irrigate our pouches regularly in the beginning and then over time many of us do it on a regular basis. I tend to irrigate my pouch almost daily and sometimes at every intubation  (often more than once until I have cleared out my pouch) ...some people believe that it is one of the reasons why we tend to have less incidence with pouchitis...I have no idea if it is true or not but my pouch feels better after irrigation. 

I do not use warn water especially but whatever is "on tap". If I am dealing with sludge then I may prefer warm to cold.

Sharon 

@skn69 posted:

Not sure if this is pertinent or not but as a k pouch we are taught to irrigate our pouches regularly in the beginning and then over time many of us do it on a regular basis. I tend to irrigate my pouch almost daily and sometimes at every intubation  (often more than once until I have cleared out my pouch) ...some people believe that it is one of the reasons why we tend to have less incidence with pouchitis...I have no idea if it is true or not but my pouch feels better after irrigation.

I do not use warn water especially but whatever is "on tap". If I am dealing with sludge then I may prefer warm to cold.

Sharon

Hello Sharon,

I have a Jpouch 18 years. I’ve been doing pretty well with a few bouts of pouchitis. For a week I’ve been constipated but going a little. I’ve been so nervous about using a fleet Enema. I really found your post so interesting. Do you suggest water over the saline? I guess I was afraid of hurting the pouch, but seems like a lot of people are doing it.

thank you,

Kathy

@Katkando posted:

Hello Sharon,

I have a Jpouch 18 years. I’ve been doing pretty well with a few bouts of pouchitis. For a week I’ve been constipated but going a little. I’ve been so nervous about using a fleet Enema. I really found your post so interesting. Do you suggest water over the saline? I guess I was afraid of hurting the pouch, but seems like a lot of people are doing it.

thank you,

Kathy

Kathy, don’t use the irritating solution that comes in the Fleet’s bottle - definitely replace it with water of whatever temperature you like. The stock solution is intended to force the muscular rectum (which we don’t have) to empty.

@Scott F posted:

Kathy, don’t use the irritating solution that comes in the Fleet’s bottle - definitely replace it with water of whatever temperature you like. The stock solution is intended to force the muscular rectum (which we don’t have) to empty.

Scott,

thank you so much! I haven’t used anything. I’ve been to afraid. Appreciate you!
Kathy

Hi Kathy,

after my surgeon recommended warm water enemas, I have tried it several times over the past year.  I used an empty fleet bottle. It did the job and gently emptied the pouch.  I think you are safe to try it.

I agree with Scott on definitely using warm water instead of the sodium phosphate solution that comes in the Fleet's. I'm occasionally lazy and think, "what the hell, " and use the Fleet's solution in a new bottle. Then I regret it with a very irritated anus.

I use a warm water enema 2-3 times per day. Without them, I cannot empty my pouch. I also use prune juice daily to keep things easier to empty but prefer the enemas. Even carry one with me to work in case the day runs long. I'm also hoping to avoid build up in my sinus tract. This pouch thing sucks!

Oh, one more point. I was thoroughly wash and reuse the enema bottles. No need to throw them out after each use if you keep them clean.

Good luck.

Can anyone advise how long you would usually "hold" the water in your pouch prior to attempting to empty?  I recall in my UC days, I was advised to try and hold in whatever medicine / suppository for as long as possible for medical effect.  Would this be similar?

I've been experiencing what seems to be some very incomplete emptying over the past 6-8+ weeks and am looking for some remedy while I wait for my appt.  I marvel at how easy you all discuss the enema process, as it takes me forever to get it loaded and dispensed (if even at all) - and @Pouch2021 even does it at work!!  Any tips/tricks? I'd love for it to be a 5 minute process that helps!

There’s no need to hold it for any particular amount of time - there’s no medicine in a tap water enema that needs time to be absorbed. What steps are you finding difficult or time consuming? I find it easiest  on my left side with the top knee drawn up. I only do enemas before pouchoscopies.

I try to hold in the warm water as long as I can so it has a chance to loosen things up (sorry TMI!). I insert the enema kneeling on all fours. If I’m at home I do some gymnastics after to move the liquid around   but if anywhere else I get off my carefully constructed paper towel mat ASAP. Just like with UC, I’ve learned where the hidden, cleaner bathrooms are at work. I also make sure x2 that the door is locked to hopefully avoid sharing my bare ass, down on all floors, with my colleagues. The whole process of filling and inserting takes < 1 min. Hope this helps.

Are you just taking a small amount of water..a cup or so?

Depends on how full the pouch is. In the AM with a full pouch I usually get about 1/2 to 2/3 of a fleet bottle in (using warm water). I often do 2 enemas back to back and can get most of the bottle in on the second go around. I just fill the pouch until I feel a pressure like sensation. Sometimes if I insert too much I get an uncomfortable pinching pain in my left lower quadrant which goes away immediately when I empty.