Peristeen New User with Concerns

[John Davis]

Yesterday morning I had a bad day, Peristeen-wise. I had three balloons pop during irrigations. One catheter was new and two were reused. The first one popped at only three pumps of air and 300ml of water, the second at four pumps of air and 350ml of water, and the final one at four pumps of air and 900ml of water.

The balloon pops all occurred during contractions. Otherwise, there was no reason for the first balloon to pop at only three air pumps and 300ml of water. I am beginning to think that my laxatives may still be acting and causing, or adding to, contractions, perhaps making them stronger than otherwise might be the case. The contractions themselves, while strong, don't really bother me as I am so accustomed to traditional soapsuds enemas. I may need to back down a bit on the laxatives and discuss this with my SCI rehab doc. Has anyone else had similar experiences?

--John

[SCI-Nurse]

Do you use Enemeez Plus-it has Benzocaine 20 mgs in it. And lidocaine on peri steen tip and with lidocaine withdig stim? The “ caines” are anesthetic and might reduce the pain. CWO

[SCI-Nurse]

I would agree with CWO - using lidocaine should decrease the pain and thus, decrease the contractions. Give it a shot - no pun intened.
ckf

[John Davis]

My hearty thanks to both of you! Yes, I am using Enemeez-Plus.

I have not tried lidocaine on the tip of the catheter or for digistims. I presume it is OTC?

I take Baclofen three times a day (prescribed) and will try taking it prior to the Peristeen irrigations. It is a muscle relaxer but I am unsure whether it will act on colonic/rectal muscles. Any advice?

[SCI-Nurse]

No, baclofen has little or no effect on the colon or intestinal track muscles, as they are smooth, not striated muscle. The anal sphincter though it striated muscle, as is the external urinary sphincter, so may be effected by baclofen. (KLD)

[John Davis]

Thank you KLD. Incontinence has really been a learning experience and the learning continues.

[John Davis]

SCI-Nurses, I need some help. With regard to your recommendation to use Lidocaine on the catheter and with digistims, can you recommend a specific product? I did some research with Google and on Amazon but am overwhelmed by the number of "rectal" products with Lidocaine. Some, although marked as "rectal," are listed in the fine print as intended for external use only.

Thanks!
--John

[NW-Will]

I use .. lidocaine hydrochloride jelly 2% 30ml, barely lasts me a month.

Am now down to 6 digistims.. so huge improvement.. still taking about 80 minutes though.
Enemeez-Plus - 20 minutes.
First peristeen - 20 minutes.
One digistim.
Second peristeen - 20 minutes
Four Digistims
Clean up.
Lidocaine digistim.. not really a digistim.. more a lidocaine application to calim things down.
One wipe with Witch Hazel wipe.

[mikeinbmore]

Wow!
This thread has really grown legs since I first started it. Glad to see so many people finding success and or getting useful information. I myself have gotten better results since I first reached out for advice. It seems that I had forgot or neglected one of the steps that I was instructed to implement when I was trained. I had not been using the Metamucil. Well once I began using it, things started looking up and I had much greater success.
My wife has been mentioning flaxseed as an alternative to Metamucil. I'm hoping someone can chime in and let me know if this is a viable alternative or if I should stick with Metamucil?

[John Davis]

NW-Will, Thanks very much for the Lidocaine info. I will give it a try. Re the digistims, as you are doing two irrigations with Peristeen, why not eliminate the earlier digistims and only do them after the second irrigation? If the bowel has some fecal matter after the first irrigation, that will not be a problem for the second irrigation.

Hi Mike! Thanks for starting this thread. I read your earlier posts. The earlier posts here contain invaluable information for a newbie like me. It is so very difficult to find accurate and specific information on this topic. I'm afraid that I can't advise re Metamucil vs flax seed as my docs actually had me lower the amount of fiber I was taking as it was making my stools too large and very difficult to pass.

--John

[NW-Will]

I'll give it at try... constant fine tuning

NW-Will, Thanks very much for the Lidocaine info. I will give it a try. Re the digistims, as you are doing two irrigations with Peristeen, why not eliminate the earlier digistims and only do them after the second irrigation? If the bowel has some fecal matter after the first irrigation, that will not be a problem for the second irrigation.

Hi Mike! Thanks for starting this thread. I read your earlier posts. The earlier posts here contain invaluable information for a newbie like me. It is so very difficult to find accurate and specific information on this topic. I'm afraid that I can't advise re Metamucil vs flax seed as my docs actually had me lower the amount of fiber I was taking as it was making my stools too large and very difficult to pass.

--John

[John Davis]

It seems I miscounted how many days I have used Peristeen irrigation (I forgot to log some days). I am surprised to see that I have used it for 80 days - without a bowel accident. I had bad GI problems one day after irrigating but that was not the fault of the Peristeen system. IMHO, 80 days is a commendable track record. I never expected to go so long without another "accident." Of course, like NW-Will, I have been constantly fine-tuning my routine as I learn more (and thanks NW-Will).

Here is a new question - how much should/does your heart rate increase during irrigation? Is there a "normal?"

My heart rate particularly increases during contractions when I am about 500ml or more through emptying the bag. Normally I would not have noticed, but my wife gave me a new Apple 6 watch that has a function to monitor heartbeats. Should I presume that the same maximum heart rate for exercise for a man of my age (approved by my primary doctor) also would be the desired maximum during irrigation? If an SCI-Nurse reads this I would appreciate your comment.

--John

[John Davis]

My thanks to NW-Will and SCI Nurses CFK and CWO for their recommendations to use Lidocaine to reduce my strong rectal cramps that were popping catheter balloons. Fortunately, I am able to reuse catheters and that did not present a major problem.

I told my SCI Rehab doctor who treats my neurogenic bowel and she wrote a prescription for Lidocaine Hydrochloride Jelly 2%. This appears to be the same as NW-Will uses. Thankfully, it seems to have worked!

However, I had sticker shock when I saw the price for that little tube of medicine! Fortunately my insurance covered most of it.

Thanks to the Peristeen system, I think I now have gone 95 days without a bowel accident. I never expected this degree of success. Perhaps Coloplast should use me for an advertisement?

--John

[SCI-Nurse]

Good to hear. I think having the person to talk with at Coloplast is important. Contact their marketing department! CWO

[John Davis]

Today is my 134th day to use the Peristeen Irrigation system. I again will state that it can work extremely well (if appropriate for your situation). However, one must be willing to accept that there will be a learning curve. It may be necessary to make small adjustments to optimize the system to one’s personal situation, anatomically, medically, physically and emotionally. Wow, that was a mouthful, wasn’t it. Anyway, I have made it for 134 days now with no accidents. I think that is absolutely incredible. It sure beats messing my pants (actually a diaper) at least several times a week, if not more. My SCI rehab doctor was amazed.

I was getting frequent catheter balloon pops, due to strong rectal contractions. NW-Will advised me to pre-inflate the catheter balloon before using it to reduce the number of balloon pops. That was a great recommendation. My small variation is to wet the catheter, inflate the balloon to 7 or 8 full pumps, wait 10 seconds, and deflate the balloon. I then reinsert the deflated balloon back into the packet of water for 10 seconds to be sure the all of hydrophilic lubrication is activated and then use it. I now am getting very few pops.

I also am using a Lidocaine 2% gel approved for rectal use (requires prescription) to help reduce my very strong rectal contractions.

The combination of the two items above collectively have been very effective.

Best wishes to all,

—John

[NW-Will]

Just checking back in.. you're keeping me honest John, thanks again for all your motivation and slowly working forward.

My update:

I am now down to a consistent 4 digital stims per Bowel Program.
I'm still reusing the catheter and haven't had a balloon burst in so long following this procedure.. When I open a fresh catheter I inflate it with TEN pumps deflate and repeat. Some catheters definitely have issues inflating evenly, but after this I can see they inflate evenly and have no issues.

I using one enemeez plus, then I wait 20 minutes.
Then insert peristeen pump in the whole bag of water wait 15 minutes... sometime I get a good evacuation of the water other times not.
Then re-insert peristeen pump in a second bag of water wait 20 minutes ... the majority of times I get a good evacuation of water at this point.
Then 4 digital stims, sometimes this just proves to be a precaution, others times it helps evacuate the water etc.

Total procedure coming in at about 90 minutes now, setup, cleanup etc..

No accidents since the last post.

I do have an increasing hemorrhoid issue which I have an appointment for.

I have also learned that some folks use more than one enemeez plus per BP, seems to be a couple of different strategies. Just use 2 enemeez plus's up front, and use one, wait a while then use the second one.

Thoughts?

This one probably requires it's own thread, but wondering what folks thoughts are on the new fangled bidet devices, I know several able bodied folks who can't speak more highly about them.

Just as an example of what I am talking about... https://bidetking.com/products/alpha-jx-bidet-toilet-seat