Other Antegrade Enema Solutions

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Other Antegrade Enema Solutions
When starting an antegrade enema program, it takes a little trial and error to find out what volume and what solution is best for that individual. In younger children this typically will be resolved within three to six months. In older children, it can frequently take 12 months or longer to find a program that works well. This is because the colon has been stretched out for so long in older children that it takes more time to regain its tone.

The continent cecostomy is a port to deliver antegrade enemas, and many different enema solutions exist.

  1. Normal saline is very safe and generally very effective. Typically, this will be used for the first three months or so after beginning an antegrade enema program.

    In terms of volume, children less than eight years of age typically will start on volumes of 300 to 500 cc every other day, and work up to 750 to 2000 cc every other day.

    Children eight years or older typically will start on 500 to 700 cc per day and work up to 1000 to 2000 cc per day.

  2. Tap water can be used. It is important to recognize that softened water should not be used because of the amount of sodium that is in it.

  3. Instilling 10 to 30 cc of mineral oil through the catheter 10 minutes before the antegrade enema frequently will help speed up emptying of the colon.

  4. Fleets green phosphosoda enemas can be used, but should be used rarely. Retention of these enema solutions can cause severe electrolyte disturbances. They should be used only infrequently, that is, once a month at most. They should never be doubled up.

  5. Soapsuds enemas can be given. The recipe for this is one tsp. of Castile soap in
    1 quart of water.

  6. Sterile saline solution can be made at home by boiling water and adding 1 tsp. of salt per 500 cc of water. It is important not to use salt substitute, because salt substitute has a lot of potassium in it. Do not use softened water. If you have softened water, either use sterile normal saline, or buy distilled water, boil it, and add the table salt.

  7. Milk and molasses enemas can be given. Use one ounce of Milk (any kind is fine, preferably whole milk) plus one ounce of Molasses (Blackstrap) per year of age, up to 12 ounces of each maximum.

  8. Licorice enemas can be used. A concentration of licorice for this can not be located.

Helpful Antegrade Enema Hints
  1. Some families have tried stretching out the antegrade enemas to every three to four days. Most families find that every four days is too infrequent, with bowel accidents in between.

  2. If catheterization via the stoma is becoming difficult, it is best to place the catheter into the stoma and then tape the catheter in place for 24 to 72 hours to help soften up the stoma and prevent closing. This can be done even on a once a week basis. The catheter should be capped when it is in place to avoid spilling stool. If no caps are available, fold the catheter back onto itself and use a twist tie from a bread loaf to kink.

  3. A coat hanger can be used on the shower curtain rod to hold the enema bag up.

  4. Be very careful about sitting on a hard toilet seat for long periods of time, we do not want pressure ulcers to develop. A padded toilet seat is good idea. Standing up every five to ten minutes is also a good idea.

  5. A little laptop desk or something like this is a good idea. This way, the child can read a book or do homework. An encyclopedia is good for this. Younger children can color or play while sitting on the toilet.