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Thread: Peristeen/Anal Irrigation? Benefits Vs Risks

  1. #1

    Peristeen/Anal Irrigation? Benefits Vs Risks

    I have not seen any posts here, and am wondering what the consensus is so far?

    For anyone unfamiliar, Peristeen (a product manufactured by Coloplast) uses a method of enema delivery to lower bowel for evacuation, on average 800 CC's slowly placed into the lower bowel via an enema tube and balloon system. Peristeen has been legal and utilized much in Europe, and has just been approved by the FDA here in the USA.

    I have been using this system to GREAT success, after 25 years of poor performance with high fiberdiet, water galore, Peri Colace & Colace, suppositories, and vigorous stimulation, which resultred in AWFUL hemorhoids/ligation and general irritation and pain in that whole area

    MY QUESTION - I do still have worries about renal issues, I to date have NO history of kidney disease, regular ultrasound and Creatnine (sp?) have been totally normal, am I risking kidneys at all by doing an enema every other day? I have followed the Apparalyzed boards closely, and seen noone with any issues, but want to raise the issue.

    I AM having rampant UTI issues since leaving external cath 3 years ago, 7-8 rounds antibiotics per year, am in process of trying D-Mannose, Graperfruit Seed Extract, and Microcyn infusions. Cystoscopy shows TONS of sediment, which doc feels is harboring bacteria. I have heavy chills with symptoms, what sensitivity I have doesnt feel like flank pain at all, but as of 4 months ago have had some fluid build up on left leg ONLY, BUT that appeared after a fall onto hardwood floors during transfer, still easy to worry its kidney related (I'm quite neurotic:)

    Any thoughts?

    Any feedback greatly appreciated!

    Lee

  2. #2
    We have discussed it at length in the past here, but since the old post search function is not working (and the older posts may no longer exist) it is hard for a new person like you to know this.

    Peristeen has been used for many years in Europe, but only recently had been available in the USA. It is still not well known. Coloplast has been spending a lot of time trying to get insurance companies to fund it, including state Medicaid programs, with limited success, so those using it have mostly had to private pay here. It can be expensive if you don't reuse the rectal catheters (which is how it is sold).

    I have seen nothing about any issues with damage to the kidneys from use of Peristeen. The water does not stay in your intestine long enough to be significantly absorbed by your body, and even if some is, this should not damage your kidneys unless you already have minimally functional kidneys.

    What are you doing for bladder management now that you are no longer using reflex voiding?? Has your urologist proposed flushing the sludge or sand out of your bladder during a cystoscopy?? It is not a difficult procedure. Do you still have significant hydronephrosis?? Swelling of one leg is much more likely to be due to a fracture or deep vein thrombosis than it is to kidney dysfunction.

    (KLD)

  3. #3
    [SIZE=12px]when i use the PIE system, i add 1.2 oz of un no iodine or kosher salt to the water, for 5 gallons i add 6 oz. I found the difference between by weight and bt measuring cup was negligible i grind the salt with a blade coffee grinder and add almost boiling water to mix it in 1 or 2 liter nalgene bottles . Many times i use 10 to 20 gallons of water , i make a solution out of potassium chloride sodium chloride, , gatorade if i have it, anything to keep the electrolytes in balance. [/SIZE]
    [SIZE=12px]I am using a lot more water than peristeen,plus i am holding it longer , and lying on my left side . Massaging my colon from ascending to descending , concentrating on any areas that i feel cramps in, makes a huge , unbelievable , increase in output. I also add about 10 enemeez to the first 3 gallons and try to do pulse irrigation, which holds it in and gently moves the water in and out. The enemmez really make a huge difference. i wish i could find usp DSS liquid, but all i have found has had dye in it.. I may try miralax in the water.too. .[/SIZE]
    [SIZE=12px]I don't use the PIE enough to be able to use 5 gallons. I cab barely layout over my bathtub, with butt over bathtub, since i have had too many messy, long cleanup treatments.. I have so much on my plate i really dont have the time to do it, , and may get a ACE/MACE soon. [/SIZE]
    [SIZE=12px]i recommend massaging clockwise even at the vault area, it can make a huge difference. The info on the salt to wateratio i got from one of the other cc memebers who alos designed a device that would replicate most of the PIE , for about 20 bucks or so. He is a mechanical engineer, and knows his stuff. In case anyone at cc that had help or was able to do it themselves, both are hard by yourself, the PIE and homemeade.. But alas it looks like MACE for me, [/SIZE]

  4. #4
    If I am reading your post correctly, you are adding elements to the "regular" enema, thus trying to keep the electrolytes in balance. I would urge you to be careful with this, since it is not adhering to the manufacturer's instructions. Massaging can most definitely assist the process, whether it be with the PIE, or with any other type of bowel management program.
    CKF

  5. #5
    Ack! My apologies for late reply SCIN, was away this weekend:)

    Thank you for your questions

    Bladder - after 23 yrs of reflex voiding/neurogenesis, I now do IC and have had a consistent 7-8 UTIs a year, ALL staph, sometimes more, yuck, after my last cystoscopy I am CONVINCED the constant UTIs are from excessive buildup of 'sludge/sand' which was VERY thick on cystoscopy, yes they did drain it then, but I'm sure after a week or so it is back. My plan is to begin D-Mannose & grapefruit seed extract, along with using Microcyn introduced once a day, and use closed cath system, theory is the sludge is harboring bacteria.

    HEADACHES - I have had since starting using Peristeen/anal irrigation and are a real pain in my day and work, usually morning after I eat first meal, concentrated in shoulders and neck, sure I worry about electrolyte imbalance but blood labs always show normal, and regular use of Gatorade or coconut water after evacuation doesnt seem to make a difference. If I lay down for 10-15 mins this neutralizes headache. BUT coincidentally I started IC a few months before starting Peristeen and also began having the UTIs and increased colonized infection, making a differential diagnosis for headaches between Peristeen OR chronic urinary tract infection is driving me NUTS (I have read many on forums complain of headaches with rampant UTIs/colonized infection). Any ideas?

    Apologies, dont want to hijack a Peristeen thread, perhaps I'll start another personal thread

    On topic - I am using materials purchased seperately (silicon balloon enema nozzle and enema bag), do not have an actual Peristeen in hand, but do exact same procedure, however due to size and height I do about 1500 CC's of water, less just isnt effective

    Lee

  6. #6
    I am sorry I didn't respond sooner, but I was having problems getting my "Posts" to post yesterday. Will try to remember what I wrote yesterday. What is your level of injury? Are you possibly experiencing autonomic dysreflexia with both of these events? It is not uncommon if your injury is at T6 or above to have an episode with either a UTI or Bowel Management programs. Have you taken your blood pressure during these episodes? CKF

  7. #7
    No worries, thank you for responding!

    I am C5-6 incomplete. AD is definitely a suspicion, though the nature of these headaches is very different from anything in my past. I DO have 2 instances of taking blood pressure during a headache and BP being way high, say 136/100 when my resting is usually 90/60.

    The pattern - I wake, exercise, eat a big meal and it starts 15 or so mins later. Laying down 15 or so mins 'breaks' it, and usually doesnt return again until perhaps the next day, never had 2 in 1 day. 3 things preceded onset:

    1. switch to IM and rampant UTI activity

    2. Began using Peristeen/anal irrigation, first true consistent evacuation I've had since injury 23 years ago

    3. Stopped Prozac after 11 years

  8. #8
    I would speak to your physician about the possibility that this may be AD. Your blood pressure speaks volumes as does the fact that laying down seems to break the cycle. (this decreases your BP). Also the triggers being bowel and bladder - speak to AD. I don't think the stop in Prozac has anything to do with it, but I could be wrong.
    CKF

  9. #9
    I was reading about peristeen here if you want to check out. There are some good questions and answers - http://inspiredsciforum.com/thread/287/peristeen

  10. #10
    I had never heard of this system before Here is a YouTube video on it http://www.youtube.com/watch?v=l6sWaD6d2Sk
    It is similar to the PIE system http://piemed.com
    I think it is a viable solution to bowel programs for spinal cord injured persons but I agree with SCI-Nurse CKF above that you have to watch Autonomic dysreflexia triggers that can occur.
    pbr

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