Anal Irrigation Systems

Anal irrigation may be recommended by specialists only when other less invasive methods of bowel management have failed to adequately control constipation and/ or faecal incontinence.

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.

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).

Whilst independent or non-NHS nurses may be involved in individual patient assessment, communication with the GP should always be via the NHS Bladder and Bowel Care team.

GPs may be asked to prescribe anal irrigation systems; choice of product is patient specific and individualised depending on a number of factors. 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 monthly. Specific details of required products (and monthly quantities) will be provided to GPs by the NHS Bladder and Bowel Care team.

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.

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

Contact NHS Bladder & Bowel Care Service:

  • Exeter: 01392 208478
  • Newton Abbot: 01626 324685
  • South Molton: 01392 675336

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 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 mobility (e.g. obesity, back or shoulder problems).

Aquaflush Compact®
  • 1 pump, 15 cones, 15 glove/disposal bags: AFCM (£58.00)
  • Extension tube – pack of 2: AFExtn (£6.12)

Notes

  1. The single use cones are not hydrophilic coated so patients require an additional lubricant (included in the pack)
  2. The hand pump is changed after 30 days
  3. Extension tubes (where required) are replaced every 30 days
Qufora Irrisedo Mini®
  • 1 pump, 1 conebag, 15 hydrophilic coated cones: 53601-015 (£59.00)
  • 1 pump, 1 conebag, 30 hydrophilic coated cones: 53601-030 (£118.00)
  • Accessory set – 15 additional cones (for patients who irrigate more than once a day): 52601-015 (£59.00)
  • Extension tube – pack of 15: 52715-015 (£45.00)

Notes

  1. The single use cones are hydrophilic coated and do not usually require additional lubrication
  2. The hand pump is changed after 30 days
  3. Extension tubes (where required) 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.

Aquaflush Lite®
  • 1 water bag, 1 pump, 16 silicone cones, 16 sachets of lubricant: AFLM (£95.00)
  • Extension tube – pack of 2: AFExtn (£6.12)

Notes

  1. For patients who require less water for irrigation to achieve desired results
  2. The single use cones are not hydrophilic coated so patients require an additional lubricant (included in the pack)
  3. The water bag is changed after 30 days
  4. Extension tubes (where required) are replaced every 30 days
Aquaflush Quick®
  • 1 water bag, 1 pump, 15 silicone cones, 15 glove/disposal bags: AFQM (£99.00)
  • Extension tube – pack of 2: AFExtn (£6.12)

Notes

  1. The single use cones are not hydrophilic coated so patients require an additional lubricant (included in the pack)
  2. The water bag is changed after 30 days
  3. Extension tubes (where required) are replaced every 30 days
Qufora Irrisedo Cone Toilet System®
  • 1 pump, 1 water bag, 15 hydrophilic coated cones, 15 waste bags: QTM (£101.66)
  • Accessory set - 15 additional cones (for patients who irrigate more than once a day): 52601-015 (£59.00)
  • Extension tube – pack of 15: 52715-015 (£45.00)

Notes

  1. The single use cones are hydrophilic coated and do not usually require additional lubrication
  2. The water bag/hand pump is changed after 30 days
  3. Extension tubes (where required) are single use

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®
  • System – 1 control unit, 1 water container, 1 tube set, 2 rectal catheters, 1 accessory set (lanyard, leg straps, tube clips), 1 case: 69005 (£74.62)
  • Consumable set – 1 water container, 15 rectal catheters: 69003 (£129.27)
  • Control unit – each: 69013 (£57.56)
  • Tube set – 1 catheter tube, 1 water container tube: 69011 (£8.83)
  • Rectal catheters – pack of 10: 68940 (£81.44)

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
Peristeen®
  • System (regular) – 1 control unit, 2 rectal (regular) catheters, 1 water bag, 2 straps: 29121 (£76.90)
  • System (small) – 1 control unit, 2 rectal (small) catheters, 1 water bag, 1 strap: 29126 (£76.90)
  • Accessory unit (regular) – 1 water bag, 15 rectal (regular) catheters: 29122 (£134.02)
  • Accessory unit (small) – 1 water bag, 15 rectal (small) catheters: 29127 (£134.02)
  • Rectal catheters (regular) – pack of 10: 29123 (£85.69)
  • Rectal catheters (small) – pack of 10: 29128 (£85.69)

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).

IryPump S®
  • IryPump S set – 1 IryPump Station, 1 power supply, 1 IryPump container, 1 IryCone (with tube): 29120E (£498.76)
  • IryCone+ – cone and tubing: 29220E (£61.19)
  • IryPump water container: 29240 (£42.37)

Notes

  1. Cone system. This system consists of a reusable cone and tube (replaced every 3 months), a water container (replaced every 6 months) and an electric pump (manufacturer guaranteed for 3 years but many patients get longer usage)
  2. The specialist nurse can provide patients with a pump on 'loan' for an initial trial (cone, tube and water container will need to be prescribed). If the trial is successful, specialist services will discuss the outcomes with the patient's GP, including a cost comparison with a comparable manual system, if requested
Navina Smart®
  • 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

 

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