Q. I’m 33 and in my 10th year as a T6 complete para. I’ve been having problems with bowel accidents — almost on a monthly basis. I’m tired of the worry and embarrassment of suddenly having to leave work “sick” because of an accident. It also puts stress on my leisure time. I’ve been seeing a buzz on chat rooms about a bowel management system called Peristeen. Does it help avoid bowel accidents? What is it and how does it work? These accidents are really getting me down.
Felix

A. Felix, according to research studies like the one published on NursingTimes.net (see resources) as well as experts, including Teri Martini, RN, BSN, program manager of Cincinnati Children’s Hospital Colorectal Center, regular use of Peristeen reduces bowel accidents, prevents constipation, and as a bonus, reduces rates of urinary tract infection.

Manufactured by Coloplast, the Peristeen system introduces tap water into the colon, which loosens stool and acts as a mild irritant, causing peristalsis — wave-like colon contractions that move and evacuate stool. The entire system fits into a travel bag the size of a shaving kit. The system was introduced in Europe in 2006 and received FDA approval for use in the United States in October 2012. It includes a 1,000 ml. clear plastic water bag, which is filled with lukewarm tap water that travels via tubing through a small hand-held control unit and a squeeze-ball hand-pump to another tube with a twist-lock on the end that connects to a hydrophilic-coated rectal catheter.

The system is designed to be used while sitting on the commode. The user (or an attendant) gently inserts the catheter into the rectum and squeezes the hand pump with the control dial on the “balloon” setting. This inflates a Foley-style balloon inside the rectum that keeps the catheter in place and ensures that water travels into the colon rather than squirting out — a common problem with enemas. Next, the dial is turned to the “water” setting. Squeezing the hand pump puts water into the colon. The water bag, marked in 100 ml. increments, enables monitoring the correct amount of water. When the water is in the colon, the dial is turned to “deflate,” the balloon empties and the catheter is removed.  Bowel evacuation takes place, on average, in 20-30 minutes. Peristeen is a prescription item and requires a 45-minute training session by a nurse or physician prior to its first use.

“If you’re happy with your bowel method and it’s working, don’t change it!” says Martini. Peristeen is considered a “second tier” system, something to try when conservative methods like digital stimulation and suppositories aren’t working. “We see a lot of people who have tried various methods that aren’t working and the Peristeen does,” she says. Josh Jaycox, 29, a game streamer from Seattle, Wash., is one of them.

“I’ve had bowel problems all of my life,” says Jaycox. “For years I had chronic constipation. I tried everything from digital stimulation and suppositories to enemas. The water ran right out — nothing worked. I couldn’t completely empty. Then I would have bowel accidents.”

A nurse at University of Washington Medical Center suggested Jaycox try Peristeen. “I’ve been using it for three months and it works great! I use it every day. It cleans me out and for the first time I don’t have to worry about accidents. I’m going to start working out, now that I don’t have to fear an accident from straining while lifting weights.”

Chronic constipation, especially with neurogenic bowel (damage to nerves that control the bowel), causes the colon to stretch and lose its ability to move stool, causing more constipation — a vicious cycle that can cause a dilated or mega colon (severely enlarged). Regularly emptying the colon with Peristeen can stop this process and, if caught early, can help the colon return to normal size.

Peristeen helps stop bowel accidents by emptying a great deal of the colon. Martini attended a conference in Europe where a physician explained how he watched an ultrasound image that showed fluid going up the descending colon and across the transverse colon — two-thirds of the entire colon. The balloon keeps the fluid from running out and the pump gives the fluid a little oomph. Considering the average length of the adult colon, emptying two-thirds of it provides a good safety margin for bowel accident prevention.

The system also helps prevent UTIs, says Martini. Because it reduces bowel accidents, it also reduces the chance of E. coli contamination from an accident. “In people with frequent UTIs, our urologists will have us check for and deal with chronic constipation, which we find often takes care of chronic UTIs as well. Large amounts of stool in the colon can put pressure on the bladder and prevent it from filling as much as it should and can also prevent the bladder from emptying all the way.

Most important now is getting insurance companies to understand the importance of the system so they will reimburse it, says Martini. Coloplast has applied for a Medicare HCPCS code for Peristeen. Approval is expected by November. When the code is granted, approval from other insurers will be much easier. At present the system is being approved in quite a few states through Medicaid and more are being added. Various private insurance companies are paying for it, but it may take a few appeal processes. As always, it is important to get documentation on why you need the system and get prior authorization. Coloplast is working with suppliers to help educate insurance companies on the importance of the system.

Arguably the most dramatic example of how Peristeen can help comes from Clint Chaney, 30, a web developer/designer and C6 quad, eight years post-injury, from Lansing, Ill. An incomplete injury combined with five and a half years of hard work enabled Chaney to walk up to 300 feet with a walker. Then he got slammed by severe stomach pain, cramping and incontinence that kept him in bed or a recliner for two years. Muscle atrophy followed, resulting in loss of his walking ability, and he spiraled into deep depression.

Doctors tested for everything possible and couldn’t find anything wrong.  Then his doctor had him try Peristeen. Within a month his stomach had returned to normal — no stomach pain, no accidents. He is still on the system, still doing great.

“It gave me my life back,” says Chaney. “I’m out with my family and friends and back to being the all-around happy person I was.” He is also working out to regain his ability to walk. “If it wasn’t for the Peristeen system, I would be depressed and might have given up.”

Resources

• Nursing Times, “Transanal Irrigation for Bowel Management”
• Peristeen by Coloplast
• Peristeen questions

Advice in this column is supported by Craig Hospital’s SCI Nurse Advice Line, a toll-free hotline for people living with SCI, a community service partially funded by grants from the PVA Education Foundation, Craig H. Nielsen Foundation and Caring for Colorado Foundation. For non-emergency nursing information about SCI health, call 800/247-0257 between 9 a.m. and 4 p.m. Mountain time. If you have a health question, contact Bob Vogel at rhvshark@mac.com.