Just Started. looking for help

[Dnl83]

I just started irrigating 10 days ago. I have been wanting to try it since last September after my APR surgery for rectal cancer. But i had 14 weeks of small intestinal blockage & other complications , so it has taken me a long time to get to this point. So far i have been able to have output each morning, but 3-4 mornings i have output after the 1 hour mark; sometimes 1.5 hours to 2 hours. I have been instilling approx. 1 liter water, warm; in about 10 minutes, but i often have to move the cone around to keep the water flowing. Other info: i take very high doses of pain meds for what my oncologist says is probably scar tissue (fingers crossed); i take half dose miralax each night; i take symphonic daily (a new med to help narcotic-induced constipation); and i had chemo-radiation for the first rectal cancer occurrence 2.5 years ago. My 3 main questions/concerns are: 1) why am i still having output after an hour? 2) i am having this slimy, yellowish, mucus-like discharge from my stoma all day long since i started irrigating; what’s causing it? 3) my stoma has become very swollen & slightly painful; have i injured it irrigating?

[ot dave]

Hey Dnl83,

Welcome to the irrigation boards.
Sounds like you have several things going on all at once that could be complicating matters.
Learning to irrigate is very much like a marathon, not a sprint. It may take you a while to figure out a routine that works best for you. Keep in mind, we are all different in our irrigating experiences.
To answer your questions:
1.) You may be getting what we call "late returns" because you are not getting your colon completely empty. For me, one infusion is not sufficient to get a good "cleaning". For me, the best routine is multiple infusions. I infuse 1500cc. Wait on returns. I infuse another 1500cc which help to get output that was hiding in corners and such I then infuse a 3rd 1500cc as my "mop up" infusion. This ensures, for me, a day without output. When I initially started irrigating, I only did one infusion of 500cc and got those later returns later in the day. I had to work out a routine that seemed to work best for me. I would suggest adding another infusion after your first returns are complete, and see if that makes a difference for you.
2.) Your colon is constantly producing mucous to aid in the movement of output. Sometimes, if the water is too warm, it may produce more in order to help protect/heal any irritations. Sounds like you may be having mucous combined with more liquid output after your initial infusion. You may find that the second infusion will clean you out more completley, which will likely decrease this kind of output. I simply call is "spooge" for lack of a better term!
3.) With the pain meds you are taking, your colon is likely spending a lot of time in a resting state (limited peristalsis). When this happens, you stoma will "expand", or seem larger. During peristalsis, your stoma will contract, and appear smaller and tighter. It will cycle between rest and peristalsis. I think you would have had to get really rough with the stoma in order to injure it with irrigation. The pain could be a number of things, from nerve endings, to scar tissue, etc.

Try to establish a consistent routine. Same time of day, same amount of water infused, same temperature of water used, etc. Try that for a week and record your results. If you''re not getting what you want, change it up, and repeat for another week, keeping a consistent routine.

As you noted, you have a lot of other things at play here, that may have an effect on your success, such as pain meds, possible scar tissue, meds to decrease impact of pain meds, etc.....

Hope I gave you a useful tip somewhere in there. Others will be along to share their experiences. We like new "gatelets"!

David

[Dnl83]

Thanks Dave! I think i will try the multiple infusions. One question there: how long do you wait between infusions? Just infuse again right after the first return?

Another question: would it be safe for me to try to insert my finger into my stoma & feel which direction its going? If so, should i wear a glove to prevent infection? Sometimes i think the cone may be pointing the wrong direction.

That’s interesting about the water being too warm; i think that may very well be the case with me. I had been going with approx. 102-104 degrees because it cools down so fast & I was taking quite a bit of time at first to get the cone in right, etc.

[ot dave]

For me, it's kind of a "gut feeling" as to when to do the next infusion. I will play on an iTouch when I'm irrigating, and I'll play a game of Suduko in between the infusions. That is usually 3-5 minutes. If I feel like the first infusion is out, then I'll do the second infusion. If I'm still feeling a little cramping or "fullness", I might wait a few more minutes. I rarely wait more than 7-10 minutes between infusions. Now, if I go and start the second infusion, and the water isn't going in, I will stop and give it a few more minutes.

Yes, it is safe to insert your finger to see the direction that your colon is headed. I have done this in the past without any issues. I usually do it in the shower where I am able to wash my hand right away. Plus, if there is any output, it goes right down the drain. I do keep a spray bottle of bleach water in the shower to spray out when I'm finished, just in case there is any output. Just be careful with your finger nails, as they can scratch the lining pretty easily as the lining is full of capillaries that will bleed easily with the right amount of force. When you think the cone is pointed in the wrong direction, try pulling back just a little bit. Sometimes the end of the cone may be resting right up against your colon, therefore keeping the water from infusing.

I like to irrigate with warmer water. It works best for me. I have done it with cold water, and the process was much longer, and not nearly as effective. I think the warmer water helps to "loosen" up the stool, which makes it easier to irrigate. Plus, with heat, things expand, which would also include the colon. Expansion of the colon leads to peristalsis, which is what we are desiring to occur when we irrigate....win win!!

Hope that helps.

David

[Dnl83]

Thanks Dave! All very helpful info. I tried infusion twice this am. But waited about 20 min.;Probably a bit too long. But so far have had no additional output; so seems to be a good solution!

[Mikem]

Hi Dnl83,
Good job making it this far. Dave has provided good guidance.
It will likely take a some time to find your best solution which is different for everyone. It will also vary over time and perfection is not guaranteed so make sure you are always prepared.
Some of us use 4 infusions and obtain 48 hrs. Not as easy or often for me nowadays so I have to be prepared if all I am wearing is a patch.
The 102 - 104 water sounds correct, it is what I try for. No warmer than 104. Above that and I believe you will have problems such as excessive mucous production.
In addition to adjusting the angle of the cone, I often jiggle the cone in an out which seems to help if it is not flowing.
Best of Luck
MikeM

[Dnl83]

Thank you Mike for your input. I will keep in mind what you said about not going above 104 degrees. I still haven’t gone to wearing just a patch yet. But I think I’m getting close. I really want to try it tomorrow or Monday though, since it’s Memorial Day & I’d really like to go sit out by the pool at my condo complex & not feel quite as self-conscious as I would with the standard bag/pouch.