Antegrade Enema

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How to give an Antegrade Enema
After your child has a cecostomy, an enema administration bag is used to give your child an antegrade enema. Follow these steps:
  1. Have your child sit on the toilet.

  2. Unplug the appendicostomy tube and attach the enema tubing to that tube.

  3. Unclamp the tubing and let the solution flow in at a fairly rapid rate. The solution should take 15-20 minutes to flow in.

  4. If the child experiences discomfort, slow the rate.

  5. When all the solution has been instilled, disconnect and replug the catheter end.

  6. The child should stay on the toilet until no more solution is passing. This may take 30-60 minutes.

  7. It is allowed and even preferred to let the child stand up and relieve skin pressure before sitting on the toilet again. If the child cannot stand, weight-shifting by leaning from one side to the other for a few minutes will be helpful also to prevent skin breakdown.

  8. Give your child an enema every other day. Doing this around the same time every other day will help establish a routine, predictable time for a bowel movement.

  9. Ask your child's doctor if your child should take a stool softener or fiber supplement. Your child should drink plenty of water and follow a diet that is high in fiber.


Antegrade Enema Preparing the enema solution

For at least the first 3 months after surgery, sterile normal saline should be used for the irrigation. Sterile normal saline is not expensive. Some choose to make their own saline by boiling tap water and adding 2 teaspoons of salt per quart of water. There are some concerns with using tap water, due to the risk of infection.


Why does a retrograde enema not always work?

The usual method of giving an enema is retrograde, which means trying to empty as much of the bowel as possible upwards from the rectum. This usually only empties the stool that is in the rectal vault. Stool that is higher up in the colon often moves into the rectum long before it is time for the next enema. If the child is constipated, a retrograde enema will not work. The water going into the rectum will hit the "wall" of stool and come back out as fast as it came in. To avoid constipation, eat a high fiber diet and drink lots of water. For more information on fiber and water, click here: Increasing Fiber and Water
Retrograde Enema