If you’ve ever sat through a late-night infomercial, you’ve heard all about the miracle products that are “as easy as one, two, three!” If you’ve ever bought anything from one, then you're likely also familiar with the notion that if something sounds too good to be true… it probably is. Some of the most significant changes don’t happen instantly, even with the best tools available.
As told by Navina user Kent Revedal
Such is the case with transanal irrigation (TAI): it's not all that easy, at least not in the beginning. The statistics are clear about that. However, after using TAI for over five years, I can honestly say these days it's a bigger hassle to make breakfast. But that's not where I started, and it's not always an easy road.
Many people stop using TAI within the first few months. I'm sure it wasn't the right solution for some of them, but my guess for many is that the drop-off was because TAI was a bit tricky to learn and they had nobody to help them through that stage.
As a peer user, I'd like to share some practical TAI advice I have discovered in hopes that a few of these tricks may be useful for you as well. TAI isn’t always easy, but it's worth sticking with.
Do What Works for You
My regimen has evolved in the time since I've started using TAI. For example, I now irrigate every third day instead of every other, which was my schedule during the first few years. Our bodies are constantly changing, and the better we know them, the better we can adjust. That's true for everything in our lives, so listen to your body – how does it seem to react?
Long before I even started with TAI, I was told that my bowels should be emptied in the mornings. But that hasn't worked out for me, and I needed to find my own rhythm. Mornings can stress me out, and I really had to take the time I need without the pressure of having to be somewhere else directly after. If you're in the same boat, take a look at your routine and find something that is realistic for you.
Treat Your Body Well
It takes time with the bowel, and not just in the “grab an extra magazine” kind of way. Getting the bowel to adjust to a new situation takes a while, but I’ve found that creating routines for eating and emptying helps it fall into a better place. I try to avoid constipation by making sure I drink enough water, especially in the summer or when traveling to warmer climates. Maintaining a relatively healthy diet also is recommended. It helps your body, plus you'll feel better as well.
Experiment with Water Usage
Speaking of water, your prescriber will recommend the amount you should use for TAI. I personally use about 500-600 ml; that's a good amount for my body and regimen. With this volume, I can feel the water reaching up to where the intestines make a 90-degree turn, just below the ribs on my left side. Some people use more or less. Bowel treatment is an art and science, so you may need to experiment to find your own way. Keep the dialogue open with your prescriber so you can work out the best plan for your body.
Add Some Pressure
Several people put the water container on the floor during TAI. There’s nothing wrong with that, but you will need to increase pressure in order to pump the water into your bowel. I put a towel on my wheelchair’s seat and place the container there, that way I’ll need less pressure in order to pump the water. If you don't use a wheelchair, you can try using another chair or the sink instead.
Having a spinal cord injury (SCI), I have no control over my sphincter muscle – and it's the same for most of my peers. Even among professionals, a common misconception is that you shouldn’t use TAI if you cannot control your sphincter. That's just incorrect. In fact, I see holding onto the catheter as an advantage.
The water needs to move past the stool to irrigate the bowel, and it can take some time for the bowel to expand enough for this to happen. When it does, my hand feels added pressure on the balloon and I know it’s time to stop filling and wait. I may even massage my stomach to help the procedure along. When I feel that the pressure decrease, I resume the process of adding water. If I wasn't holding the catheter while this was happening, it would be more difficult to know when it's time to pause or resume.
Get a Routine
Emptying your bowel using traditional methods can take a lot of time when you have an SCI, and I frequently am asked how long everything takes. I can usually expect to be done in less than an hour, including the time it takes to take a shower afterward. Bear in mind this time frame is after a lot of practice, and it may take you a little longer at first. Don’t get discouraged if you need more time as you get the hang of TAI.
My normal routine is as follows:
- First, I empty my bladder. Otherwise it will affect the transanal irrigation.
- Then I insert the catheter and fill the bowel with water, which takes 3-5 minutes.
- I take out the catheter and wait about 15-20 minutes.
- Then the emptying itself happens, which takes somewhere between 5 and 15 minutes.
- In my own routine I always take a shower afterwards. It makes me feel clean and it minimizes the bacteria in that area, something I'm sure has a positive effect on reducing the risk of UTI.
Many TAI instructional videos show how easy it is for the stool to pass after irrigation. To return to the beginning of this post, be wary of anything that sounds too good to be true. It does not work that easy for me at least.
Here are some bonus tricks I’ve picked up to move things along:
- Insert a finger to help the sphincter relax enough for the stool to pass. This also seems to trigger the reflexes, which helps a lot.
- If the bowel does not start by itself, try to massage the stomach downwards.
- Lean forward if possible.
I hope some of these ideas will help you with your bowel management!