Orthograde colonic irrigation is a preparatory procedure for colon cleansing so that colonoscopy can be performed on it afterwards. Orthograde colonic irrigation is also standard medical practice when preparing for certain abdominal surgical procedures.
What is orthograde colonic irrigation?
Orthograde colonic irrigation is used to prepare for bowel examinations so that the physician has an unobstructed view of the bowel mucosa during a colonoscopy. Orthograde colonic lavages are used to prepare for bowel examinations so that the physician has an unobstructed view of the bowel mucosa during a colonoscopy. Stool residue in particular can make a clear view of the mucosa difficult or impossible altogether, and the corresponding bowel sections cannot then be assessed diagnostically. As a rule, orthograde colonic irrigation is performed in the morning before the examination or the day before. Orthograde colonic irrigation is to be understood as a bowel cleansing process in which it is necessary for the patient to orally supply not inconsiderable amounts of various fluids during a defined period of time for complete bowel emptying. Most patients find this drinking process, but also the subsequent bowel emptying, rather unpleasant, as severe diarrhea may well occur. The first evacuations can be expected about an hour after the start of oral intake of the irrigation solution. The irrigation solutions and medications must each be tailored to a patient’s body weight and general condition.
Function, effect, and goals
An orthograde colonic lavage begins with the administration of a polyethylene glycol solution, PEG. IT is 3 to 5 liters of solution, which should be drunk completely within only a few hours. The PEG solution has aroma and flavor additives. Nothing else should be eaten or drunk during the bowel cleansing except clear non-carbonated water. To prevent feelings of nausea, a suppository containing the antiemetic agent dimenhydrinate may also be administered. Orthograde colonic irrigation should be performed by patients until only a golden yellow liquid, as clear as possible without solid components, is excreted. To further stimulate bowel peristalsis, a laxative can be administered in addition to the lavage. If patients suffer from chronic constipation as a result of laxative abuse, then the additional administration of a laxative is obligatory, because otherwise the goal of a completely cleansed intestinal mucosa can hardly be achieved. Some patients are also unable to consume such large amounts of fluid in such a short time. In these cases, it is possible to administer the irrigation solutions by stomach tube, a variant that is even preferred by some patients. Shortly before the examination, a so-called high enema may also be necessary, to which the laxative bisacodyl is added. This laxative has an immediate laxative effect and thus removes any remaining stool from the anus. Orthograde colonic lavage is used in particular for preparation for major abdominal surgery, for preparation for a so-called colon contrast enema, and for complete bowel evacuation prior to colonoscopy, jejunostomy, and ileoscopy. The preparatory actions for orthograde colonic irrigation also include medical information about its purpose and risks. The risks of the orthograde colonoscopy itself are very low, but the risks of the subsequent examinations are much higher. During the consultation, the patient’s questions regarding the procedure and the performance of orthograde colonic irrigation are discussed in detail. Orthograde colonic irrigation is a medical examination that must be documented, and the physician is therefore obliged to provide comprehensive information. The result of the discussion is documented in writing with the signatures of the physician and the patient. The preparation also includes a physical examination with determination of the initial weight. The materials required for an orthograde colonic lavage performed as an inpatient include a commode chair, a so-called plug-in basin, and a balance sheet on the fluid supplied. In addition to the actual irrigation fluid, the patient can also drink up to 12 liters of isotonic saline solution, which usually results in intentional osmotic diarrhea. Follow-up after completion of the examination is also important.The patient must continue to be observed and his vital signs, consciousness and fluid balance monitored for a period of time individually defined by the physician. Orthograde colonic irrigation can also be performed on incontinent patients if so-called incontinence clips are applied beforehand. All materials used must be disposed of properly.
Risks, side effects, and hazards
Orthograde colonic irrigation cannot be performed in certain contraindications because the risks are too high. Absolute contraindications include mechanical and paralytic ileus, intestinal stenosis of other etiologies, bleeding, and severe inflammation of the gastrointestinal tract in addition to severe cardiac and renal insufficiency. This is because if the heart or kidneys are severely diseased, the large amount of fluid used in orthograde bowel irrigation can quickly lead to significant, even life-threatening complications. The degree of weakness of the heart or kidneys is determined by the preliminary medical findings from physical examination, imaging procedures and laboratory values. In each individual case, therefore, a medical decision must be made as to whether or not Orthograde colonic irrigation can be performed. Orthograde colonic irrigation is often confused with enema. However, the latter is not used for diagnostic purposes, but only for the quick removal of a stool blockage. It happens again and again that an orthograde colonic irrigation has to be terminated prematurely. In the case of unknown or unrecognized pre-existing conditions, vital signs may suddenly change due to circulatory problems, resulting in immediate discontinuation of the irrigation procedure. Also, if the patient suffers from severe abdominal cramps or pain after entering the irrigation solutions, the orthograde colonic irrigation must be terminated prematurely. The administration of pain medication during an ongoing orthograde colonic irrigation is not usual and is reserved for exceptional cases. Also, if the patient suffers from severe abdominal cramps or pain after entering the irrigation solutions, the Orthograde colonic irrigation must be stopped prematurely. The administration of analgesics during an ongoing Orthograde colonic irrigation is not usual and reserved for exceptional cases.
