New "Bottom Doc" and exam

[JDinVirginia]

After moving to the Raleigh, NC area I was concerned about finding a good colo-rectal surgeon who also was either tolerant or approving of my use of daily preventive enemas to control my fecal incontinence. Some physicians consider the topic to be below their level of skill or interest and more appropriate for nurses. To me it is critical as the preventive enemas give me my freedom for most of the day without stressing over a possible accident.

I lucked out and found an excellent doctor who was knowledgeable, understanding, and very communicative. After reviewing my medical records and performing a "bottom check" the only new problem is some small hemorrhoids.

He reviewed my bowel incontinence symptoms and walked me through my entire nema procedure in great detail, right down to the volume, height of bag, teaspoons of salt and soap and electrolyte balance and approved of what I am doing. He even approved of my enema exercises. Did anyone even know that there is such a thing as enema exercises? They are gentle exercises performed during the holding period to increase the efficiency of the enema. Remember - my procedure needs to be more effective than what one would do for simple constipation.

As I administer the enemas while flat on the floor (to reduce water pressure on the anus and get the solution higher in the colon), he reviewed my options as I age and getting up or down from the floor becomes too difficult or my remaining sphincter muscles are unable to hold the enema. There is the implant of an electrical stimulator - which would not give me as much reduction in accidents as I currently get from my enemas. Then there is the Coloplast Peristeen enema apparatus which is designed for those with spinal cord injuries and is administered sitting on a toilet (a doughnut shaped device on the nozzle inflates with water to form a seal inside the rectum during the enema). Finally there is the MACE Malone Antegrade Enema wherein a stoma is surgically inserted through the stomach and into the colon. Then an apparatus is used to insert into the stoma and administer an enema "from the top down." I think I would go with the Peristeen as long as I could, and then the MACE stoma. All of this sounds strange to the uninitiated, but we cope and carry on.

This is good news for me in that I have faith in the new doctor and have options.

Of course, there is still the matter of the urinary incontinence.

--John

[batman381327]

It is always nice to find a doctor who listens.

[ILuvLA]

Glad you were able to find a new "bottom" doc this is "top" notch.

[4wheeldave]

Your sounding really positive about all this which has to be a good thing.
Well done in finding the right Doc.

4wheeldave.

[JDinVirginia]

"Stiff upper lip and carry on," right Dave?

--John

[tangerine]

Great that you've found a good doctor I did some research in to peristeen a while back as it was recommendee to me at one point. It turned out not to be suitable for me but the system itself looks good. A lot of people seen to get on really well with it.

[JDinVirginia]

Tangerine, if and when I get to the point that I need it, the Peristeen system would enable me to take an enema while seated on the toilet. At present my limited sphincter muscle control just does not allow me to do that.

Being able to administer the enema while seated on the toilet means that I could eliminate my current risk of serious leaks while holding on the floor or getting up from the floor and transferring to the toilet.

It also would make the procedure a little easier when traveling (hotels, cruise ships). For fear of serious leaks, when on long travel with limited luggage I usually must administer the enemas while I am lying or kneeling in the bathtub or shower as I will not have enough absorbent pads in my luggage to protect the floor from leaks. TMI but a reality for me.

However, in the U.S. as the FDA has only recently approved the Peristeen system, most insurance companies will not cover the expense. The basic apparatus is not too expensive, but the monthly cost of the single-use nozzles with the auto-inflating Foley-type balloons is quite high!

--John

[wheels5894]

Glad to hear you have found a good doctor!

If you do try the Peristeen system I'd be interested in seeing how you get on. I have wondered about it myself as I tend to pass 'rocks' at irregular intervals and have thought a regular wash-out would be helpful.

[JDinVirginia]

wheels, the Peristeen system should work for you. It was developed for persons with SCI needing some assist with bowel functions.

The device is mechanically simple and has accessories to make it more manageable by those with limited dexterity or hand strength. On the down side, as is the case with most medical devices, it is a little expensive unless your insurance or health service pays for it.

The foley-type catheter or enema nozzle has an inflatable balloon which, once inserted, automatically fills with water. I believe the diameter of the filled "doughnut" is about 2" (5cm) which should insure that the nozzle remains securely in the rectum, forming a seal, without the need to hold it with a hand. Although these catheters are listed as "single-use," many users report that they are able to use them more than once, often 3-4 times.

As my insurance currently does not cover the Peristeen system, I will not be able to conduct a test in the near future. However, the Peristeen has been the subject of several medical research studies and has received high marks from the subjects.

--John

[wheels5894]

Thanks for that, John. I'll have a chat with my doctor next time I see him and maybe the continence advisor could help out with this as well as help with some training for use if she thinks I am suitable.