Skip to content

Rectal Treatment for Inflammatory Bowel Disease

  • by

This DVD has been developed by Dr. Andrew Robinson (Consultant Gastroenterologist) and Cath Stanfield (Specialist IBD Nurse). Salford Royal NHS Foundation Trust.

This dvd contains information for anyone who’s been prescribed an enema or suppository by their doctor or nurse for the treatments of ulcerative colitis you can move between sections of the dvd that you think might be useful to you the first section gives an introduction to inflammatory bowel disease and the treatments that may have been prescribed to help alleviate

The symptoms many patients have further sections demonstrate how to use a foam enema liquid enema or suppositories according to what has been prescribed by your doctor or nurse these sections are to help you become more familiar with using the device to get the best results possible the final section of the dvd contains some frequently asked questions that may

Be useful to you as a patient there are several different rectal preparations available and administration of each may vary slightly so it’s important to read the pack patient information leaflet before using the product inflammatory bowel disease or ibd is a group of chronic inflammatory diseases that affect some people without a clear specific reason as to why

This occurs in some people and not others a wide variety of factors are believed to be involved which range from genetic to environmental ulcerative colitis and crohn’s disease are the two most common forms of ibd at any given time they’ll be about a hundred and twenty thousand people with ulcerative colitis in the uk about one in five hundred each year between

Six and twelve thousand new cases are diagnosed crohn’s disease affects approximately 60,000 people or one in a thousand between three and six thousand new cases are diagnosed each year together these conditions affect one in four hundred of the uk population in most of these cases the left side of the colon and rectum are affected ulcerative colitis and crohn’s

Disease affect different parts of the gastrointestinal tract ulcerative colitis can affect the rectum and colon or large intestine crohn’s disease can affect anywhere throughout the gastrointestinal tract from mouth to anus but is most common in the distal part of the small intestine and the first part of the colon ibd causes changes to occur in the lining of

The gastrointestinal tract including ulcers and scarring these changes are visible to a doctor or nurse when they perform an endoscopy for the purpose of this dvd we’ll be concentrating on ulcerative colitis which affects the colon and rectum treatments of ulcerative colitis may vary depending on where the disease is mainly located this may be limited to the

Rectum proctitis involved the recto sigmoid colon proptosis igniters or the descending colon up to the splenic flexure left-sided colitis these areas of involvement are collectively called distal colitis or distal disease if the whole of the colon is affected this is called pan colitis this involves the entire colon extending from the rectum to the start of the

Small intestine about 40 to 60% of patients suffer from prato sigmoid itis 20 to 30 percent from left-sided colitis and 15 to 20 percent from pang colitis treatment options include oral therapy tablets or granules and rectal therapy foam and liquid enemas and suppositories depending on where the disease occurs if there is pain colitis the inflammation extends

Beyond the reach of enemas alone and an oral therapy will be required on its own or in combination with rectal therapy the bloody diarrhea and unpleasant symptoms associated with ulcerative colitis are a result of the inflammation the disease causes the aim of treatment is to control this inflammation and reduce the symptoms treating distal disease locally and

Quickly is important as it’s believed that reducing inflammation quickly may prevent the disease becoming more extensive rectal treatment in the form of foam or liquid enemas and suppositories is therefore very common for many patients as they try to control local inflammation in distal disease the choice of which rectal treatment to use foam or liquid enemas or

Suppository will be made depending on where the disease is located and in discussion with the patient regarding personal preference there are two current classes of drugs for disease located in the distal area based on available evidence the british society of gastroenterology and european echo guidelines recommend the use of masala zine as the first choice however

If a response is not seen to occur with the chosen rectal treatment within an agreed time and the symptoms are not well controlled rectal steroids may be considered as an alternative or additional treatment to control the disease maintain the effect and delay progression it’s important to remember to take the treatment prescribed on a regular basis even if the

Symptoms are improving evidence is clear that not maintaining the treatments for ulcerative colitis does lead to a fivefold risk of recurrence of the disease the remainder of this dvd focuses on demonstrating how to use specific foam or liquid enemas and suppositories in this demonstration one box of rectal foam enemas contains a can of masala zine sufficient for

14 applications the box contains 14 disposable applicators to be used together with the spray 14 disposable plastic bags are also provided for hygienic disposal of the applicators applicators are coated with a special lubricant and packed individually in a white plastic container a separate applicator is used for each administration of the enema the enema itself

Is made of three parts a pump dome canister and spray tip wash your hands before use holding the applicators tightly you need to pull out one applicator and attach it onto the spray tip by pressing firmly prior to its first use you must break the protective strip located between the canister and the pump dome then rotate the pump dome until the semi circle marked

Part of the pump dome aligns with the spray tip it’s recommended to shake the canister for about 20 seconds prior to each use place your forefinger on the pump dome and turn the canister upside down the spray will only work properly when held with the pump dome pointing down at a right angle there are several ways to apply the rectal foam effectively it may be

Used standing as well as in the lying position when applied standing place one foot on a higher surface such as a chair or stool in order to facilitate the application the foam applicator should be placed inside the rectum firmly press the pump dome once as the dome is pressed down the cap fills with foam the foam is only released into the rectum once the dome is

Slowly released for a second dose repeat the same procedure without removing the applicator from the rectum to ensure the foam spreads effectively the applicator should be held in position for 10 to 15 seconds before withdrawing it’s normally for small amount of foam comes out after the application dispose of the soiled applicator in the plastic bag provided after

Completing the application avoid accidental leaks from the canister by rotating the pump away from the semi circle shaped camp so the spray tip is not able to be pushed down the best results are obtained when the bowels are emptied prior to using the enema and at bedtime as keeping the phone within the bowel for an extended period will increase its effectiveness

If you’re having difficulty in retaining the phone it can be administered in divided doses one at bedtime and one in the morning one box of rectal foam used with two pump applications per treatment can be used for up to seven days finally wash your hands after use the liquid enema box in this demonstration contains seven individual blister packed bottles each

Intended for single-use the enema itself consists of three parts an applicator a unidirectional valve system and an accordion reservoir to help the application the flexible applicators are coated with special lubricant and kept inside a protective cover the uni directional valve system contained in this enema means the liquid enema is prevented from flowing back

Into the reservoir once inserted into the bowel the practical accordion reservoir also ensures that a patient can use the enema on their own and the active substance can be administered completely unless otherwise recommended the entire contents of an enema should be applied completely for best results the bowel should be emptied prior to administration prior to

Youth wash your hands and shake the enema bottle well for about 30 seconds take off the protective cover and hold it in a vertical position in order to prevent the contents pouring out to apply the enema you need to lie down on the left side of your body with your left leg extended pull your right leg towards your stomach and position your right knee on the side

You’re lying in order to ensure balance insert the pre-lubricated applicator tip into the rectum press the accordion reservoir slowly ensuring the medicine is emptied into the bowel after the application removed the empty bottle from the rectum and dispose of the used bottle to help the medicine the spread evenly inside the bowel it’s recommended to remain lying

In the same position for at least 30 minutes or as long as possible finally wash your hands after youth you prior to use wash your hands in this demonstration the suppository needs to be removed from the plastic strip suppositories may be used standing as well as in the lying position the action of suppositories is often enhanced if you lie on the left side when

Introducing the suppository for ease of use vaseline or some lubrication may be applied to the suppository before insertion and may help the application for some people others find that it helps to run the suppository under warm water prior to application once this has been done the suppository should be gently inserted into the rectum with the pointed end first

Some patients find it useful to remain lying on the left side after administration to help retention finally wash your hands after use is it normal to have some leakage it is common for patients to leak some of their enema contents after use this usually settles as your symptoms of active colitis begin to resolve if you do experience leakage you may find it useful

To use the enema earlier in the evening so that you can have a shower before going to bed some patients find it useful to wear an incontinence pad so they do not have to worry about leakage during the night if my symptoms get better do i have to continue to use the enema it is generally recommended that you continue with your enema therapy until you have seven

Days of no symptoms unless advised otherwise by your doctor or specialist nurse you may find it useful to keep a supply of enemas at home so if you have any signs of rectal bleeding you can recommence your therapy immediately you should let your hospital team know if your symptoms fail to settle is it normal to feel pain when using the application you should not

Feel any pain when using the applicator it can feel uncomfortable but this can be relieved using lubricant on the applicator or by running warm water over the applicator before use you should try and be as relaxed as possible during administration is it normal to have some bleeding when using the enema you shouldn’t experience any rectal bleeding on insertion of

The enema however when you pass the contents of the enema in your next bowel movement you may notice some blood then this may be in the toilet bowl or within the stool this is normal if the amount of blood you pass increases you should speak to your doctor or specialist nurse i find it very difficult to keep the liquid foam in for very long before i need to go to

The toilet it’s common when people first use their enemies to get a sensation that they need to go to the toilet immediately you should continue with your therapy even if this happens as you’ll still get some benefit from the enema and usually over a period of a week or so your ability to retain your enema will increase to increase the likelihood of retaining your

Enema you should relax as much as possible best results are obtained if you empty your bowel prior to administering your enema put a towel on your bed and try to take your mind off the pressure you may feel in your back passage you could try reading listening to music or watching some television if possible if you’re still experiencing problems after a week or 10

Days you should speak to your specialists team can a carer administer my enema some patients find it difficult to administer their enemas independently if you have a carer who’s willing to help you with your enemies’ you should follow the instructions as outlined in this dvd for further information on ibd and it’s treatments you may wish to visit the crohn’s and

Colitis nacc website wwe city uk or dr. falk farmer wwd our funko uk where patient information is available

Transcribed from video
Rectal Treatment for Inflammatory Bowel Disease By Alicia Sisi