Rectal Irrigation with IryPump®S Time machine – 48 hours of freedom ... over and over again

Irrigation

Contents 03 | General information on rectal irrigation

17 | Contraindications

04 | The intestine - anatomy and physiology

19 | Irrigation for Children

08 | Fecal incontinence

21 | The procedure step by step

09 | Causes

28 | Products for rectal irrigation from the B. Braun range

11 | Fecal incontinence - what to do about it? 13 | Rectal Irrigation with Irycone 15 | Rectal Irrigation - key facts

General information on rectal irrigation Incontinence is defined as an inability to voluntarily retain urine and/or stool and to expel them, at a time and place the individual chooses for themselves. Information on the subject of incontinence is also to be found by searching for the term ‚incontinence‘. Often, incontinence will initially develop as a side effect of something else. If, however, the illness that triggers the condition is not treated, the incontinence can grow and may become difficult to treat. For this reason, it is extremely important to confide in your doctor once the first signs appear.

By asking the right questions and making the right examinations, your doctor will be in a position to establish what the cause is and whether the underlying illness and the incontinence itself can be treated or, at least, alleviated. Urinary incontinence affects people of all ages, but is increasingly more common the older we get: 15% of women and 8% of men over the age of 56 years old may be affected by it. Current estimates suggest that around four million people are affected by incontinence in Germany. This guide is designed to help you continue to live the life you want, without restrictions, day after day.

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The intestine - anatomy and physiology Our digestive system is made up of a network of tubes that, with its many functions, takes care of absorbing and transforming the foods we eat, as well as eliminating substances that our bodies cannot digest. The whole digestive process from taking in food to expelling the parts of it the body cannot digest takes around 48 hours. For certain people, this time may vary. The digestion process begins in our mouths. Food we consume is broken down into smaller pieces by our teeth and mixed with saliva through chewing. The ‚bolus‘ is then transported to the stomach by way of our esophagus. The stomach stores this bolus and mixes it with its own gastric juices, preparing the components of the food to be accepted by the stomach. The bolus is then released into the small intestine via the pyloric orifice. In the first section of 4

the small intestine (duodenum), the biliary and pancreatic juices are mixed together to prepare the components of the food for their passage into the further sections of the small intestine. In the two sections of the small intestine that come next (jejunum and ileum), the food is further broken down. The smallest components of the food are absorbed by the mucous membrane of these sections of the intestine and released into the blood. Indigestible ingredients are passed on by the small intestine to the large intestine. In the large intestine, the still liquid food residues are condensed. The removal of water and effect of intestinal bacteria gives the stool its ultimate consistency. The rectum serves as a storage facility for the stool before it is discharged. When it is full, we feel the urge to defecate, and can voluntarily commence the process of emptying our bowels.

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Stomach

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Small intestine

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Cecum with appendage

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Ascending colon

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Transverse colon

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Decending colon

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Sigmoid colon

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Rectum

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Dentate line

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Anal canal

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External sphincter

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Internal sphincter

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Internal hemorrhoidal plexus

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The ‚continence organ‘ is located at the end of the intestinal tract. It consists of the inner and outer sphincter (musculus sphincter internus & externus) and a network of arteries, veins and nerves. Just as important in this area are the hemorrhoids (corpus cavernosum), which allow for the tight closure of the anal canal. When pressure increases in the rectum, a signal is sent to the brain via the spinal cord. The brain sends a signal back to the continence organ to let the sphincter relax and push the stool out of the rectum by peristalsis.

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Fecal incontinence Fecal incontinence is a terms used to describe a person‘s inability to deliberately control the bowel evacuation process.

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Fecal incontinence does not represent an illness in itself, but will most frequently be a symptom of another type of illness. Three degrees of severity have been identified:

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The bowel movement in itself can still be controlled. There is an uncontrolled release of intestinal gases. Those affected find they need to wash more often, as liquid components of the stool may also be released together with the intestinal gases in a way the sufferer cannot control.

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In contrast to degree 1, at this stage the loss of fluid is continuous and uncontrollable, combined with the escape of intestinal gases.

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The most severe form consists of a complete loss of control over the bowel emptying function, resulting in the uncontrolled and unhindered release of intestinal gases and stool.

Causes Many illnesses can lead to the occurrence of fecal incontinence. In most cases, it will be caused by an illness of the following type:

Tissue fatigue The elasticity of the tissue diminishes. The sphincter system can no longer ensure complete closure of the anal canal. This can be caused by getting older, or by having given birth several times.

Disruption of the muscle functions Traumatic injuries (perineal tears, accidents, tumors, operations) can lead to these symptoms. Chronic constipation, however, can also lead to muscular reactions caused by the continuous distension of the muscle.

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Psychological/psychiatric changes These include illnesses that can lead to changes in our personality. Adults and children are equally likely to be affected. One example is where older people regress into childhood. Depression and conflicts of roles, however, may also be a cause.

Sensory causes These can include the complete lack or impairment of feeling of rectal filling, caused in most cases by a sensory disorder of the mucous membrane that lines the anal canal. Organically, this can be due to a bowel prolapse. Severe hemorrhoids can also be an underlying cause.

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Neurological causes Neurological causes are defined as all forms of interruption to the transmission of neuromuscular stimuli. This can be caused by illnesses that lead to a failure of the stimulus-carrying nerve pathways, such as may result from a stroke, multiple sclerosis, Alzheimer‘s Disease or also by a complete breakdown of the transmission of nervous stimuli (paraplegia, spina bifida, etc.).

Fecal incontinence - what to do about it?

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The first thing to do when fecal incontinence occurs is to find out what‘s causing it. The earlier the cause is identified, the greater the chances are that therapy will prove to be successful. A number of approaches are available today for the treatment of fecal incontinence. The oldest and most well-known form of treatment is care involving the use of absorbent pads. This does not prevent involuntary defecation, but helps to catch any excrement discharged. Depending on the cause of the fecal incontinence, a change in the sufferer‘s eating habits can lead to 11

positive results, for example where it has been caused by chronic constipation. There is no generally recommended diet to ensure this, however. What is much more important is to take advice from a consultant in nutrition. It can, however, be said that sufficient intake of fiber can significantly alleviate the condition. At the same time, however, it is essential to take in sufficient quantities of liquids. Fiber can help to increase the volume of the stool, resulting in improved intestinal peristalsis. Around 30 to 60 grams of fiber is the recommended daily intake. Fruit, whole grain and vegetables are all foods that are rich in fiber. Care must be taken, however, to ensure that the intake of fiber is accompanied by sufficient quantities of fluids. 12

A lack of fluid can lead to the stool hardening and to constipation. The minimum amount of liquids currently recommended is two liters per day.

Rectal Irrigation with Irycone Irrigation is now accepted as a modern, therapeutic procedure for fecal incontinence. Irrigation enables the stool to be broken down using water. The incoming water increases pressure in the intestine, raising its activity level. For treatment to be successful, it is important to always irrigate at the same time every day. At the beginning, the procedure needs to be repeated very day. Depending on how well the intestine responds to this form of therapy, patients may not need to pass stool for up to 48 hours.

The IryPump® S is the latest development from B. Braun in the field of electrical irrigation systems and sets completely new standards in irrigation therapy in terms of design, function and handling. Safe and simple to use, adjustable to individual needs, surprisingly compact and totally portable thanks to the integrated high-performance battery – the IryPump® S will help you to achieve maximum comfort, discretion, quality of life and independence.

The major benefit of irrigation is that stool does not accumulate within the body (as it does, for example, with suction-based methods). The problems associated with that form of treatment - such as the formation of odor, visible nature of the treatment and skin problems are avoided by irrigation. 13

Headline

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Rectal Irrigation – key facts

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Before setting out irrigation procedures, a physician/nurse consultancy is compulsory in order to know whether this type of therapy is suitable for your form of fecal incontinence. It is recommended that the 1st irrigation with IryPump® should be carried out under the guidance of a trained physician/nurse in consideration of potential risks.

Irrigation must always be first discussed with the patient‘s doctor and all possible risks taken into account. Only on this doctor’s written advice is irrigation to proceed, under the guidance of appropriately trained practitioners. Once the patient becomes familiar with the equipment and procedure of irrigation, then it can be done by the patient alone.

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To achieve full emptying of the intestine at the beginning of the therapy, we recommend carrying out the irrigation in two steps. The first of these is to ‚pre-rinse‘ the bowel, which involves the injection of around 150ml of water into it. This helps to initially break down any stuck fragments of stool, which are then discharged after around 10 minutes. Once this process is over, full irrigation can start.

Should this problem not have resolved itself within four weeks, however, we recommend that you talk again with your doctor or continence advisor about adjusting the amount of water and the speed at which it is injected.

The exact amount of water needed should be decided by you together with your doctor or continence advisor. In individual cases it may be necessary to repeat the irrigation to obtain a satisfactory result.

Should you suffer from diarrhea at any time, you can stop the irrigation temporarily until your bowel function and the consistency of your stools have returned to normal. While suffering from diarrhea, we recommend that you refrain from irrigating.

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In particular at the beginning, irrigation can continue to lead to uncontrolled stool discharge. During this time, we recommend that you continue to use pads.

Adjusting your diet can also have a positive effect in determining effectiveness of the irrigation.

Contraindications

Generally speaking, anyone suffering from fecal incontinence can irrigate. There are, however, a number of exceptions: Inflammatory bowel diseases (Morbus Crohn, colitis ulcerosa) Diarrhea Fistulas or wounds in the area of the anus or rectum Infectious diseases of the intestine Cardiovascular diseases Acute phases of spinal shock Ileus (obstruction) of the intestine Verticulitis (inflamed pouches in the lining of the colon) 17

Headline

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Irrigation for children Children with anorectal malformations (such as abnormalities of the anal canal or the entire genital area), or who suffer from spina bifida (inborn damage to the spinal cord) will often be fecally incontinent from the moment they are born. Therapy by way of irrigation is often the preferred choice to enable the child to take part in everyday life without having to wear a nappy.

When irrigation is indicated, this should start from the child‘s third year of life. Irrigation prior to this point does not seem prudent as the child‘s own continence development is not yet complete. At the beginning, the irrigation should be administered by the child‘s parents. Later on, your continence advisor or doctor will be able to help your child to perform their own irrigation themselves.

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The procedure step by step All the equipment needed for irrigation (IryPump® S, non-woven swabs, cone and tubing) should be laid out prior to starting irrigation. IryPump® S

Check that the battery in the is fully charged. Important: for safety reasons, irrigation with the IryPump® S is only to be carried out when operated by battery!

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When using an electrical irrigation pump whilst travelling abroad, you may need an adapter for the power source. You may also need an information leaflet for customs when travelling by air. Further information can be obtained from the manufacturer. In countries with poor water quality, it is recommended to use shop-bought still bottled water instead of tap water.

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Turn on the IryPump® S to check if the battery is properly charged. Ring lights up green ��� the IryPump® S is charged and irrigation can begin. n



Ring lights up red ��� the IryPump® S must be charged before the next irrigation can be performed. n

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If the ring starts to blink during the course of irrigation, it will still be possible to complete the irrigation procedure which has already begun. n

The control dial of the IryPump® S will slowly blink green, while charging. n

Remove the water container from the pump module by pressing the side release tab.

Extend the water container; to do so just pull the inner section up until it audibly clicks into position (first right side, then left side).

Fill the water container with the prescribed amount of water.

Attach the filled water container back onto the pump module.

Check that the water is at the correct temperature (36 to 38°C). The temperature indicator is located at the bottom of the water container.

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Use the quick connector to fasten the tubing system onto the pump.

Connect the other end of the tubing system to the cone.

Expel all air from the tubing system by turning on the IryPump® S and setting it to flush level 3. When the tubing system is completely full with water and no more air can be seen in the tubes, turn off the IryPump® S.

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Ensure that you are in a comfortable position. Lubricate the cone and carefully insert into the anus and hold it in place by applying a slight pressure throughout the irrigation procedure.

IryCone is in place.

Switch IryPump® ON. Make sure that you keep the cone in place during the whole process.

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Now, start the irrigation. As the volume of the water in the container decreases, this shows you the water is flowing in properly. In the initial phase, it is recommended to carry out a pre-irrigation with a volume of 250ml before the main irrigation to remove any stools lodged in the rectum. 26

During irrigation the colon fills with water. This causes expansion of the intestine, which removes lodged stools and stimulates the peristalsis.

When all the water has flowed-in. Set the control dial to OFF. Leave the Cone inside for 1-2 more minutes, then carefully remove the IryCone from the anus. After a few minutes the defecation process will begin and the bowel contents will flow into the toilet with the water. The evacuation time may vary.

Rinse the tube system, and the water container out out with lukewarm water, and use warm soapy water to clean the cone. Then use a dry towel to dry the individual parts of the system.

Clean and dry your irrigation system and recharge the battery of the IryPump® S, if needed, to be ready for the next irrigation.

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Products for rectal irrigation from the B. Braun range IryPump® S | Rectal irrigation with IryCone

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IryPump® S Set

Quant. REF

Complete starter set, contains 1 set ®  IryPump S (electronical pump, water container and power supply)  IryCone®+ (cone and tubing)

29120

IryPump® S Accessories

Quant. REF

 IryCone®+   1 piece (cone and tubing)   IryPump® Power supply   1 piece IryPump® Water container   1 piece

29220 29030 29240

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Notes



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ZB00164 Edition: 01/2015