Antegrade continence enema (ACE) irrigations usually start the day after surgery. Your doctor or nurse will tell you when to begin your irrigations and teach you how to do it.

Supplies

  • 60 cc catheter-tipped syringe
  • Normal saline 

Procedure

We recommend that you sit on the toilet during irrigations. However, there may be no stool for the first few times you irrigate.

  1. Wash your hands with soap and water.
  2. Draw the saline into a syringe. (Use the amount of saline indicated on your schedule.)
  3. Insert a clean catheter into your ACE stoma.
  4. Slowly push the saline into your ACE catheter. (Note: Rapid irrigations may cause cramping. Cramping and gas may also occur if air gets into the bowel. If you experience cramping, slow down the irrigation and make sure that the saline isn’t too cold.)
  5. Wash the catheter after each use. Use antibacterial soap and water. Let the catheter air dry until your next irrigation. Replace catheters every one to two weeks.

Things to Remember

  • Stool accidents may occur until you decide the right amount of irrigation for you. Each patient is different. Some patients need to irrigate daily while others will need to irrigate every other day.
  • The catheter that was placed during your surgery will be removed about three weeks after surgery. At this time, you’ll learn how to catheterize your ACE with a straight catheter. After the catheter is removed, you will have to insert and remove a catheter each time you irrigate.
  • As you learn what works best for you, this procedure will become a simple part of your daily life. Pick a time of day to do your irrigations that will work with your schedule, preferably at the same time every day. Make sure you choose a time when you won’t be rushed.
  • If you experience constipation, it may be helpful to put 15-30 cc of mineral oil into the ACE using a catheter, just before doing the saline irrigation. You may still need to control your diet and/or use some medicines to soften or add bulk to your stool. 

Irrigation Schedule

Use normal saline. (See recipe, right.) Increase amount by 50 cc every three days.

____ 50 cc (infuse slowly with syringe)

____ 50 cc

____ 50 cc

____ 100 cc

____ 100 cc

____ 100 cc

____ 150 cc

____ 150 cc

____ 150 cc

____ 200 cc (may use enema set)

____ 200 cc

____ 200 cc

____ 250 cc

____ 250 cc

____ 250 cc

____ 300 cc

____ 300 cc

____ 300 cc

____ 350 cc

____ 350 cc

____ 350 cc

____ 400 cc

____ 400 cc

____ 400 cc

____ 450 cc  (increase by 50 cc every three days until you have good stool results) 

Normal Saline Recipe

Option One

1. Mix 1 gallon distilled water with 8 teaspoons of table salt.

2. Shake until the salt is dissolved.

Option Two

1. Boil 2 quarts of tap water for 10 minutes.

2. Add 4 teaspoons of table salt to the boiled water.

3. After the saline cools, pour it into a plastic bottle (preferably the one you received from the hospital).

This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team.