Antegrade continence enema procedure


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Many people who have spina bifida will suffer with problems of constipation and faecal incontinence. The Antegrade Continence Enema or ACE is a way of managing bowel emptying at a convenient time each day, and should reduce both constipation and soiling episodes.

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Antegrade continence enema procedure

  1. 1. 42 Park Road Peterborough PE1 2UQ 01733 555988ACE ProcedureAntegrade Continence EnemaMany people who have spina bifida will suffer with problemsof constipation and faecal incontinence. The AntegradeContinence Enema or ACE is a way of managing bowelemptying at a convenient time each day, and should reduceboth constipation and soiling episodes.The procedure involves sitting on a wall of the abdomen at the navel orcommode or toilet whilst a washout lower down below the level of mostis given through a small opening or underwear. This small opening orstoma on the abdomen. stoma is used to pass a tube called a catheter into the bowel so thatBecause creating an ACE stoma fluid can be introduced to flushrequires an operation, the doctor faeces out through the anus. This iswill usually recommend it only called an ACE washout. For peoplewhen all other efforts to manage who have previously had theirthe bowel have been tried and appendix removed, there are otherhave failed. ways of making an ACE stoma. For example, a tiny segment of smallHow does it work? bowel may be used.To create an ACE stoma, the Before the operation, you may besurgeon will cut off the appendix, admitted to the hospital for a fewstill with its blood supply, and days. This is to make sure you areconnect one end to the large well enough to have the operation,bowel and the other end to the and to empty the bowel.
  2. 2. ACE ProcedureAntegrade Continence EnemaAlthough you will not be able to if it is carried out regularly. Initially,eat and drink immediately after this may need to be daily and thesurgery, you should be up and on whole process may take as little asa normal diet after 1 or 2 days. This 30 minutes, or as long as 2 when the washouts will begin. The average time though is an hour.A soft catheter that is left in the Once you establish a good routine,stoma from surgery will be used. A you should be clean betweensolution is flushed along the bowel washouts. Remember that it takesby gravity whilst you sit on the a little while for the system to settletoilet. The solution and contents down, and the amount and/or typewill empty into the toilet. The of washout fluid may need to behospital stay will last 5 to 7 days. changed. Your nurse specialist willAfter discharge from the hospital, help with this. For some people,the catheter will stay in the stoma things seem to work out quickly andfor 4 to 6 weeks, to allow it to heal. they soon become accustomed toYou will then be asked to come doing the washouts.back to the hospital, and will betaught to catheterise the stoma so What complications canyou can do your washout and then occur?be free of a catheter until the nextwashout. Once the catheter has There can be times when thingsbeen removed, there is no leakage do not go well, for instance if youfrom the stoma as it is designed to have to take antibiotics, or you getbe leak-proof. a tummy upset. There are ways of overcoming these problems andWho is it for? with experience you will learn how to cope with them.This method of bowel managementis not a “quick fix”, and requires For a few people, complicationsa great deal of commitment and do occur. Sometimes the stomahard work to establish a reliable becomes narrow (stenosed) andwashout routine. Once a good it is increasingly difficult to pass aroutine is achieved, it will work only catheter. This can be overcome
  3. 3. by passing a catheter every day even if the washouts are not done Are there other options?daily. Sometimes it is necessary tohave further surgery to solve these Some hospitals now offer adifficulties. Some people choose to variation of this procedure thatwear a small soft plug or stopper in does not require a formal stomathe stoma to prevent it from getting to be created. However, sometight. Occasionally infections occur, form of small tube called a PEG orand they may need to be treated Button device is left in place at allwith antibiotics. times. The tube is inserted under general anaesthetic either usingBefore choosing this method of a laparoscope or a colonoscope.continence management, you This is a “pull through” methodshould consider whether you could whereby a piece of the bowel isgive the time commitment, and pulled to the surface of the skin, andhave the motivation it takes to make the button or PEG tube is work for you. Generally, ACE is Once this has healed, washoutsnot considered suitable for children can be given whilst sitting overunder the age of 5 years, as it can the toilet. The washouts work inbe very difficult to encourage them the same way. The big advantageto sit on the toilet for the length of of this procedure is that it is easytime required. to stop just by removing the tube. For some patients, the tube can beTalk to your doctor or continence placed into the left hand side of theadviser and decide together if this bowel. This usually means shorteris the way forward for you. Most washout times. This option will notpeople who have chosen the ACE be suitable for everyone however,procedure have gained immensely so it must be discussed with yourfrom it. They can do things they medical team.thought were impossible before,such as swimming and even havingsleepovers!
  4. 4. Help usShine relies on people’s generosity and support so we can help our clientswho depend on us for help and advice - people with hydrocephalus,spina bifida, their families and carers. To donate to Shine please or call 01733 421329.This information has been produced by Shine’s medical advisers andapproved by Shine’s Medical Advisory Committee of senior medicalprofessionals.Shine - Registered charity no.249338To see our full range of information sheets and to find out how to donateto Shine please visit