BOWEL WASH

BOWEL WASH – BOWEL ELIMINATION (Purpose, Contraindications, General Instructions, Methods Used, Solutions Used, Preliminary Assessment, Preparation of Patient and Environment, Equipment, Procedure and After Care)

UPDATED 2024

Bowel elimination is a basic bodily function that most people carry out in private and are often embarrassed to discuss publicly. Nurses will encounter patients with bowel elimination issues in all areas of care. Knowledge and understanding of both normal function and the problems that can occur with that process will enable nurses to support and care for patients with bowel elimination problems

BOWEL WASH

Bowel wash or colonic lavage or enteroclysis is defined as washing out colon with large quantities of solution.

Bowel irrigation or enteroclysis is defined as washing out of the colon after the feces has been expelled by using large quantities of prescribed solution

PURPOSE

To prepare for diagnostic examination or before certain surgery
To relieve inflammation
To stimulate peristalsis
To supply fluid and electrolyte those are absorbed from intestine
To dilute and remove toxic agents
To reduce temperature in hyperpyrexia
To relieve fecal incontinence
To supply medications locally
To clean the colon of feces, gas and barium
To treat infection and other pathological condition of colon

CONTRAINDICATIONS

Rectal infection
Fistula in anus
Painful and bleeding hemorrhoids
Painful skin lesions around the anus
Massive carcinoma or tumors of the rectum
Loose sphincter
Polypus and diverticula of the intestine

GENERAL INSTRUCTIONS

A cleaning enema should be given one hour before the colon irrigation
The bladder should be emptied before colonic irrigations
The temperature of the solution is kept constant throughout the procedure
Allow only 200 to 300 ml of fluid to run into the rectum at a time
Make sure that the return flow is not blocked
Use a smooth and flexible rectal tube and lubricate it well
Prevent air entry into the intestines
Stop the procedure temporarily the patient complaints of pain
Listen to the complaints of the patient and should not ignore any discomfort however small they may be

METHODS USED FOR BOWEL IRRIGATION

Funnel and catheter
Y connection and a rectal tube
Two tube method

SOLUTION USED

Tap water
Cold water
Normal saline
Sodium bicarbonate 1 to 2 %
Antiseptic solution KNMO₄
Boric solution 1 to 2 %
Tannic acid 1: 100
Alum 1: 100

TEMPERATURE OF THE SOLUTION

Cleaning purpose 104 degree F (40 degree Celcius)
Thermal effect 110 to 115 degree F (43.3 to 46 degree celcius)
Reducing temperature 80 to 90 degree F (27 to 32 degree celcius) amount of water used for bowl, irrigation is 2 to 3 liters or till the return flow is clear

PRELIMINARY ASSESSMENT

Check

Doctors order for any specific precautions
Diagnosis of the patient
General condition of the patient
Self-care ability of the patient
Mental status to follow instructions
Any contraindications
Need for any extra help
Articles available in the unit

PREPARATION OF THE PATIENT AND ENVIRONMENT

Explain the sequence of the procedure
Arrange the articles at the bed side
Provide privacy
Place the Mackintosh and towel under the patient
Place the patient in left later position
Keep the bucket on a low stool or receive the out flow of fluid
Remove the back rest and extra pillows

EQUIPMENTS

A clean tray containing

Funnel and tubing with glass connection
Mackintosh and towel
Rectal tube placed in a kidney tray
Vaseline
Rag pieces in a container
Hot and cold water in jugs
Prescribed solution in jug
Paper bag
Bucket
Toilet tray if needed
Clean linen if needed
Bath thermometer

PROCEDURE

Wash hands thoroughly
Prepare the solution at the required temperature
Attach the tubing and the rectal tube with the funnel, pour solution in it and check for any leakage
Lubricate the tip of the rectal tube about 4 inches
Separate patient’s buttocks to visualize anus clearly and insert tip of tube about 4 to 5 inches, while patient takes deep breath
Lower funnel below level of rectum and empty return flow into bucket
Fill funnel again. Pour 200 to 300 ml of fluid each time. Raise funnel and allow fluid to run continuously. When 200 to 300 ml of fluid has gone in pinch tube before tunnel is completely. Lower and invert tunnel over bucket and siphon fluid, noting characteristics of return flow
Repeat this process, till return flow is clear
Remove the rectal tube by using rag pieces

AFTER CARE