bowel irrigation

[terence]

has anyone heard of the 'malone procedure'? it involves a tube being surgically inserted into the bowel through an opening in the side which is involves minimal obtrusion. you can then sit over the toilet and wash out your bowel through the tube - no more suppositories, enemas, manuals, etc.

apparently, it is a quick, effective and convenient way of emptying the bowel. however, i haven't come across this procedure much in cases of quad/paraplegia, it seems to be used mostly with children affected by spina bifida - similar symptoms though.

would this kind of surgery be considered a viable option or only as a last resort? it sure would save time and energy if it is as effective as it is made out to be.

[SCI-Nurse]

This is also called an ACE procedure (antegrade colonic enema). It has been used most for children with spina bifida, although now is growing in popularity with adults with fecal incontinence from a variety of causes as well. It has been used more in the UK than in the USA.

The surgery is fairly simple (outpatient) and the recovery fairly easy. It is used to give yourself a daily enema through the tube, which goes into the cecum (the first section of the large bowel). Here us a site with more information. You should look at the information for professionals, not just that for patients:

http://www.cecostomy.com/

Unfortunately we have no data about the impact of long term use in adults. We do know that those who use traditional enemas long term are more subject to development of megacolon (large stretched out bowel without any muscle tone/contractions), so are cautious about using this for anything but the most intractable bowel problems that cannot be remedied with any other traditional interventions. We just did our first one here this year, and are considering a second.
(KLD)