Anal Irrigation Systems

Anal irrigation is a procedure where water is introduced through the anus to assist bowel evacuation. It may be recommended by specialists only when other less invasive methods of bowel management have failed to adequately control constipation and/ or faecal incontinence.

Assessment

A full continence assessment will be completed by specialist services (NHS Bladder and Bowel Care team) prior to considering anal irrigation systems. The NHS Bladder and Bowel Care team are responsible for initiation, patient training, and regular review of patients (at least annually).

Independent or non-NHS nurses may be involved in individual patient assessment, communication with the GP will be in conjunction with the NHS specialist team.

Following specialist assessment, GPs may be asked to prescribe anal irrigation systems.

GPs should not make product and accessory changes without discussing with the NHS Bladder and Bowel Care team; any changes must be on specialist service recommendation only.

Choice and quantity

Choice of system is patient specific and individualised depending on a number of factors, including disabilities; dexterity; cognitive ability; ability to sit on the toilet; ability to carry out the procedure independently; volume of irrigation required; and the nature of the bowel dysfunction.

Patients should be informed that they have a free choice of route of supply e.g., via community pharmacy or dispensing appliance contractor etc.

The systems are usually recommended for daily or alternate day use. Cones and rectal catheters are single use (expected usage is therefore 15-30 per month); water bags are changed approximately monthly. Specific details of required products (and monthly quantities) will be provided to GPs by the specialist team.

During or after irrigation

Mild and transient symptoms, such as abdominal pain, chills, nausea and minor rectal bleeding, may occur during or after irrigation. There is also an extremely rare risk of potentially fatal bowel perforation. Specialists should provide comprehensive training to patients/carers on how to use the specific system, how to recognise the symptoms of colonic perforation, and what actions to take.

If a patient is ordering excessive quantities or reports difficulties, please contact NHS Bladder and Bowel Care service for further advice.

  • Exeter: 01392 208478
  • Newton Abbot: 01392 208478
  • South Molton: 01392 675336
  • Torbay Hospital Biofeedback Service/Women's Health Physiotherapists: 01803 655294
  • Pelvic Floor Service, University Hospitals Plymouth NHS Trust: 01752 431166

Mini systems

These systems consist of a cone that is inserted into the anus, and a small hand pump. They are small, discreet systems that are used when only a small volume of water is required.

They are often used to help either start or complete evacuation and can be used for patients with ileoanal pouch dysfunction (on consultant surgeon recommendation) or for mucous build up in the rectal stump of patients with a stoma. They can be used with an extension tube to increase the volume of water, or for patients who have reduced flexibility (e.g. obesity, back or shoulder problems).

Aquaflush Compact (Renew Medical)
  • Starter Set (AFCS):
    • 1 pump, 5 cones, 5 gloves/disposable bags, 1 wash bag (£34.41)
  • Monthly Set (AFCM):
    • 1 pump, 15 cones, 15 glove/disposal bags (£58.79)
  • Extension Tubes (AFEXTN):
    • Pack of 2 tubes (£6.12)
  • Cone Refill Pack (AFLA):
    • 15 standard cones, 15 lubricant sachets (£58.79)

Notes

  1. Cones are not hydrophilic coated, patients will require an additional lubricant
  2. The hand pump is changed after 15 uses
  3. Extension tubes (where required) are replaced every 15 uses
Aquaflush Compact+ (Renew Medical)
  • Starter Set (AFCPS):
    • 1 pump, 5 cones, 5 disposal bags, 5 lubricant sachets, 1 wash bag, 1 extension tube (£34.42)
  • Monthly Set (AFCPM):
    • 1 pump, 15 cones, 15 disposal bags, 15 lubricant sachets: AFCPM (£58.79)
  • Extension Tubes (AFEXTN):
    • Pack of 2 tubes (£6.12)
  • Cone Refill Pack (AFLA):
    • 15 standard cones, 15 lubricant sachets (£58.79)

Notes

  1. Cones are not hydrophilic coated, patients will require an additional lubricant (included in the pack)
  2. The hand pump is changed after 15 uses
  3. Extension tubes (where required) are replaced every 15 uses
Qufora IrriSedo Mini (MacGregor Healthcare Ltd)
  • Mini System (15 irrigation set) (53601-015):
    • 1 pump, 15 hydrophilic coated cones, 15 waste bags (£60.46)
  • Mini System (30 irrigation set) (53601-030):
    • 1 pump, 1 conebag, 30 hydrophilic cones (£120.92)
  • Accessory Set (52601-015):
    • 15 hydrophilic cones (£60.46)
  • IrriSedo Extension Tubes (52715-015):
    • Pack of 15 tubes (£46.11)

Notes

  1. Cones are hydrophilic coated and do not usually require additional lubrication
  2. The hand pump is changed after 15 to 30 uses
  3. Extension tubes are single use

Cone systems

For use whilst the patient sits on or over the toilet or a commode. These systems consist of a disposable cone and an integral water bag/tubing/hand pump.

The patient needs the ability to hold the cone in the anus whilst the water is instilled either through gravity (hanging the water bag above shoulder height) or via the hand pump. Due to the cone having to be physically held in situ, these systems are not frequently used when a third party (e.g. nurse or carer) is delivering irrigation.

A self-retaining cone may be necessary for some patients, specialists will advise.

Aquaflush Lite (Renew Medical)
  • Starter Set (AFLS):
    • 1 water bag, 1 pump, 1 hook for water bag, 1 extension tube, 7 cones, 7 lubricant sachets, 1 washbag (£74.00)
  • Monthly Set (AFLM):
    • 1 water bag, 1 pump, 16 cones, 16 lubricant sachets (£96.30)
  • Extension Tubes (AFEXTN):
    • Pack of 2 tubes (£6.12)
  • Cone Refill Pack (AFLA):
    • 15 standard cones, 15 lubricant sachets (£58.79)

Notes

  1. For patients who require less water for irrigation to achieve desired results
  2. Cones are not hydrophilic coated, so patients require an additional lubricant (included in the pack)
  3. The water bag is changed after 16 uses
  4. Extension tubes (where required) are replaced every 15 uses
Qufora IrriSedo Cone Toilet System (MacGregor Healthcare Ltd)
  • Starter Set (QTS):
    • 1 pump, 1 water bag, 5 hydrophilic coated cones, 5 waste bags, 1 toilet bag (£79.73)
  • Irrigation Set (QTM):
    • 1 pump, 1 water bag, 15 hydrophilic coated cones, 15 waste bags (£104.18)
  • Accessory Set (52601-015):
    • 15 hydrophilic cones (£60.46)
  • IrriSedo Extension Tubes (52715-015):
    • Pack of 15 tubes (£46.11)

Notes

  1. Cones are hydrophilic coated and do not usually require additional lubrication
  2. The water bag is changed after 15 uses
  3. Extension tubes are single use
Aquaflush Self Retaining Cone (SRC) (Renew Medical)
  • Starter Set (AFSRCS):
    • 1 water bag, 1 pump, 1 hook for suspending water bag, 1 floor stand, 1 extension tube, 5 rectal catheters, 5 disposal bags, 1 lubricant sachet, 1 washbag (£77.00)
  • Monthly Set (AFSRCM):
    • 1 water bag, 1 pump, 1 floor stand, 15 rectal catheters, 15 disposal bags, 15 lubricant sachets (£105.00)
  • Extension Tubes (AFEXTN):
    • Pack of 2 tubes (£6.12)
  • Refill Pack (AFSRCA):
    • 15 rectal catheters, 15 disposal bags, 15 lubricant sachets (£75.00)

Notes

  1. Cones are not hydrophilic coated, patients will require an additional lubricant (included in the pack)
  2. The hand pump is changed after 15 uses
  3. Extension tubes (where required) are replaced every 15 uses

Catheter/balloon systems

For use whilst the patient sits on or over the toilet or a commode. These systems involve a rectal catheter with an integral balloon, which is inflated to hold the catheter in place in the rectum. This helps to achieve a seal to assist retention of irrigation fluid.

These systems are often used when a patient does not have the mobility or dexterity to hold a cone in the anus at the same time as using the hand pump, when a third party (eg community nurse or carer) is performing irrigation for a patient, or where assessment shows that a cone based system is not suitable for the patient.

Rectal catheters are single use only and all are hydrophilic coated so the patient will not usually require additional lubricant products.

Navina Classic (Wellspect Limited)
  • Classic System (69005):
    • 1 Navina Classic control unit, 1 water container, 1 tube set, 2 rectal catheters, 1 accessory set (lanyard, leg straps, tube clips), 1 Navina case (£77.89)
  • Classic System Small (69007):
    • 1 Navina Classic control unit, 1 water container, 1 tube set, 2 small rectal catheters, 1 accessory set (lanyard, leg straps, tube clips), 1 Navina case (£77.51)
  • Classic Control Unit (69013):
    • 1 Navina Classic control unit (£59.60)
  • Classic System Refill (69006):
    • 1 Navina Classic control unit, 1 water container, 1 tube set, 2 rectal catheters (£77.89)
  • Consumable Set (69003):
    • 15 rectal catheters, 1 water container (£134.93)
  • Consumable Set Small (69004):
    • 15 rectal catheters, 1 water container (£134.28)
  • Rectal Catheter Set (68940):
    • Pack of 10 rectal catheters (£85.01)
  • Rectal Catheter Set Small (68943):
    • Pack of 10 rectal catheters (£85.60)
  • Tube Set (69011):
    • 1 catheter tube, 1 water container tube (£9.14)

Notes

  1. Air filled balloon
  2. Control unit and tubes are replaced every 100 uses (just over 3 monthly if irrigating daily, 6 monthly if irrigating alternate days)
  3. Water container is changed every 15 uses
Qufora IrriSedo Klick (MacGregor Healthcare Ltd)
  • Starter Set (QKSTART):
    • 5 catheters, 1 Klick tube, 1 control unit, 1 water bag, 1 leg strap, 1 hook, 1 toilet bag (£87.99)
  • Catheter Set (QKCATH):
    • 15 catheters, 1 Klick tube, 1 water bag, 1 soft bag (£133.61)
  • Control Unit (QKCONTROL):
    • 1 control unit, 1 leg strap: (£50.48)

Notes

  1. Control unit should be replaced every 3 months if irrigating daily, and every 6 months if irrigating on alternate days
  2. Rectal balloon catheters are hydrophilic coated and do not usually require additional lubrication
  3. Water bag is changed every 15 uses
Peristeen Plus TAI System (Coloplast)
  • System Small – including toilet bag (29147):
    • 1 control unit, 2 rectal catheters, 1 water bag, 2 straps, 1 tube (£79.45)
  • System Small – excluding toilet bag (29148):
    • 1 control unit, 2 rectal catheters, 1 water bag, 2 straps, 1 tube (£79.45)
  • System Regular – including toilet bag (29140):
    • 1 control unit, 2 rectal catheters, 1 water bag, 2 straps, 1 tube (£79.45)
  • System Regular – excluding toilet bag (29141):
    • 1 control unit, 2 rectal catheters, 1 water bag, 2 straps, 1 tube (£79.45)
  • Accessory Unit Small (29149):
    • 15 rectal catheters, 1 water bag (£138.47)
  • Accessory Unit Regular (29142):
    • 15 rectal catheters, 1 water bag (£138.47)
  • Rectal Catheter Small (29150):
    • 10 rectal catheters (£88.53)
  • Rectal Catheter Regular (29143):
    • 10 rectal catheters (£88.53)
  • Straps (29145):
    • Pack of 10 (£5.67)
  • Tubes (29146):
    • Pack of 2 (£7.94)

Notes

  1. Air filled balloon
  2. Base set is replaced every 90 uses (3 monthly if irrigating daily, 6 monthly if irrigating alternate days)
  3. Water bag is replaced after 15 uses

Electronic pump systems

These systems use an electronic pump to control the flow of water into the rectum (rather than a hand pump). There is both a cone and a catheter/balloon based system. Due to the high initial cost of providing the pumps, these are only used under special circumstances (e.g. for individuals with limited dexterity/grip, who are unable to manage a manual pump system).

Navina Smart (Wellspect)
  • Navina Smart system – 1 control unit, 2 rectal catheters, 1 water container, 1 tube set, 1 accessory set (lanyard, leg straps and tube clips), 1 case: 69009 (£298.50)
  • Consumable set – 1 water container, 15 rectal catheters: 69003 (£129.27)
  • Control unit – each: 69014 (£300.92)
  • Tube set – 1 catheter tube, 1 water container tube: 69011 (£8.83)
  • Rectal catheters – pack of 10: 68940 (£82.10)

Notes

  1. Catheter/balloon system. This system consists of a control unit which has easy-touch buttons (similar to using a 'smart phone') which can be used for 400 uses or 2 years (whichever comes first), a water container (replace every 15 uses), tubes (replace every 100 uses) and a disposable rectal catheter
  2. There is also the facility to link this to a smart phone via an app, which can then be used to track progress and record irrigation volumes, frequency and results. The control unit settings can be set by the nurse specialist and 'locked' to prevent changes, this can be particularly useful to maintain safety and continuity where different carers are delivering irrigation or a patient has cognitive impairment
  3. The nurse specialist will assess the patient's suitability for this system using a demonstration product to ensure the patient has the ability to manage the control unit
  4. Trial units are not available – specialist services will discuss this option with the GP before commencing the patient on this system
Last updated: 12-11-2021

 

Home > Formulary > Chapters > 18. Continence > Anal Irrigation Systems

 

  • First line
  • Second line
  • Specialist
  • Hospital