How to Start a Cone Irrigation Program for Your Child With a Neurogenic Bowel from Spina Bifida or Spinal Cord Injury (SCI)

If you have a child with a neurogenic bowel- from either Spina Bifida or spinal cord injury (SCI), you know it is difficult to create and maintain a bowel program. Cone irrigation is a good option for many people who don't want to undergo surgery. Cone irrigation will help you flush out the bowels using water and an stoma irrigation kit.

Difficulty: Moderately Challenging

Instructions

Things You'll Need:

• Visi-Flow Irrigator with Stoma Cone (or another brand)
• Warm Water
• Toilet and Toilet Paper
• Towel or Water Proof Pad (optional)
• Lubricant such as KY Jelly

1. Wash your hands with soap and warm water.

2. 
   Cone Irrigation Tip

   Make sure the cone irrigation tip is attached to the tubing.

3. Unsnap the top of the bag. Put 20cc per kilogram or 100cc per 10 pounds (of child's weight)of lukewarm water in the bag. For example, a 30lb. child would need approximately 300cc of water in the bag. Tap water is fine.

4. Hang the bag 5-6 feet high. Your bathroom design will determine the best way to do this. You can put the bag on a clothes hanger and hang the hanger over your shower rod. If the shower is too far away from the toilet, you can hang the bag on a hook in the wall. If neither of these work, you can get another person to help you by holding the bag up in the air.

5. Flush water through the tubing by rolling the paddle wheel up with your thumb. Rolling the wheel up unclamps the tubing and allows water to flow through. After flushing, reclamp the tubing by rolling the paddle wheel down.

6. Open your lubricant and apply it generously to the tip of the cone.

7. Set your child on the toilet, or have them lay on a towel or waterproof mat on the floor. If your child is on the toilet, they will have to lean forward so that you can insert the cone into their rectum. Hold the cone in place and encourage your child to help you hold it. This will help them practice so that they will be able to do this by themselves in the future.

8. Roll the paddle wheel up so that the tubing unclamps. The water should be running relatively fast. If the child seems uncomfortable, or if there is leaking or spraying around the cone, roll the wheel down to pause or slow the flow of water until you can continue. Allow the water to run until the bag is empty. If the child is laying on the floor, you will need to transfer them to the toilet before taking out the cone.

9. Remove the tip of the cone from the rectum.

10. Massage the abdomen in a clockwise direction for about 5 minutes.

11. Have your child sit on the toilet for approximately 30 minutes. The exact amount of time will depend on how long it takes for the water and stool to empty from your child's body. While they are on the toilet, encourage them to bear down, make grunting noises, laugh, or do anything that might help the stool come out.

12. Clean your child's bottom and dress them in a diaper or pull up. There may be some leakage of stool the first few times you do this. Wash the cone tip with soap and water. Store the cone and bag in a clean and dry environment.

Tips & Warnings

• Begin the irrigation program by doing it once every night. Although some people continue to need to clean out their bowels daily, when your child starts becoming clean all day, you may be able to decrease to once every other night.
• Most people prefer to clean out the bowel at night. Dinner digesting helps move things along at this time of day. Also, even if there is any leakage during the night, by morning, the child is often clean enough to wear underpants for the rest of the day.
• If your child's feet do not touch the floor, put something underneath them to support their feet and legs. This helps the stool come out and makes them more comfortable.
• If you have a lot of trouble with leaking, you may need to stop the flow of water and allow some of the stool to come out before finishing the bag. Sometimes hard stool blocks the water from entering the colon and needs to be removed before you can continue.
• If your child has been having problems with constipation, you may not be able to get much stool out the first few times you use the irrigation program. Try to soften their stool by changing their diet or giving them Miralax.
• If tap water alone does not work for you, you may need to add a squirt of mild soap- such as Ivory liquid, castille soap, or baby shampoo- to the water in the bag.
• If water does not work at all, you may need to replace the water in the bag with the contents of a fleet enema.

Resources

• The Spina Bifida Association
• Buy a Visi-Flow Irrigator with Stoma Cone

[MaryGood]

on 10/3/2008 Great instructions! This program has worked for us for over 10 years. Many older children can learn to complete the procedure by themselves, allowing independence at camp and times away from home.