Peristeen Presentation

I went to the Peristeen presentation today and here is what I came away with:

Essentially, there are two aspects of the Peristeen that make it more effective than a traditional enema. First, the water goes much higher into the colon and so there is a much more extensive clean out. The presenter showed x-rays from a constipated bowel, a bowel emptied by a cone enema, and a bowel emptied by the peristeen. The peristeen cleared out much more. Therefore, if you have a leaky bowel, the leakage is happening so high up in the colon that it doesn’t exit the body. Stool can not make it all the way down the colon is less than 24 hours so there shouldn’t be any accidents.
The second aspect is that there is a catheter (there are small and standard sizes) that you insert into the rectum and then you have a pump which you squeeze between 1 and 5 times depending on the tightness of the anal sphincter. The pump blows up a balloon which acts as an artificial sphincter–holding the water in. The cone enema is more volatile.
–Coloplast recommended using it once a day for the first month and then most people can use it every other day.
–they recommend waiting until the child is 3 yrs but have used it for a child as young as 2.
–there are centers all over the US who are trained to teach parents to use it–Cincinnati is the only? one that requires a week long stay. Generally, its an outpatient training.
–Coloplast said most likely you will continue to use medication–I know Cincinnati does not use senna–they add irritants to the water solution.
–It is covered by insurance and they are working on getting Medicaid to cover it–in some states it does, some it doesn’t
–the catheter is thrown away after use–because of the balloon and also because each is lubricated.
We have had success with the cone enema up to this point but we sometimes we will have “off” days so I can see this being a better solution for us before entering kindergarten.
–camilla

14 comments

  • I know very little about this, but when you say it goes much higher up in the colon, did they address how this might affect intestinal flora?

  • The presenter didn’t mention intestinal flora at all. I do wonder if there are health benefits to just using the cone enema over the peristeen–plan to ask my nurse/doctor and look into a bit more before deciding to make the switch.

  • So I did a little research about intestinal flora and enemas, etc. What do you think about the idea of adding probiotics to the water? I don’t know much about the peristeen system. Can you add something to the water using their system?

    Just like irrigating the bladder with d-mannose sounds interesting. I find adding probiotics to an enema equally interesting.

    Livestrong indicates that they have done scientific studies on probiotic enemas:

    “Probiotic enemas have performed well during scientific studies to help reduce the symptoms associated with Colitis and other bowel disorders”

    http://www.livestrong.com/article/544136-how-to-do-a-probiotic-enema/

  • Thats really interesting–I wouldn’t have thought of adding probiotics. Once we did try adding herbs and salt and it was the one time the enema completely did not work–absolutely no stool came out. It was kinda bizarre. Salt apparently makes the water less irritating–when the irritation actually helps. But, if it doesn’t make any difference in the effectiveness, adding probiotics makes complete sense. You can add to the water with the peristeen just like you can in the cone enema. I have started increasing Claire’ s oral dosage of probiotics but I have not been able to find a lot of info about how much is ok. I read about one mom online who gave her kids adult dosages but in the brand we buy (RAW), the package says in bold print not to give to kids. But, I do give her more than the traditional children’s dosage.

  • Have you ever seen a local Naturopath? That is the type of question I would ask my ND, for sure.

    I really wish one of those Naturopathic Clinics was closer to you. The Seattle one was so impressive. The Portland Naturopathic Clinic had a doctor that specializes in brain, spine & GI. I sent his info to Tracy. I thought that was such an interesting combination of specialties.

  • Hey ladies, just as an FYI, Florastor is the probiotic recommended to my dad by his infectious disease doc to keep all manner of intestinal nasties at bay. This was the docs official regimen to keep dad healthy after repeated bouts of C. Diff.

    There is a Florastor for kids.

    Its an interesting idea. I can’t see how it would do harm, but I wonder if it would actually do any good. I’ll have to read your link,.Tspar. I would think they would mostly just wash back out.

  • Wash back out, yeah, I suppose. I hadn’t thought about that. I don’t think Livestrong cites their source on the studies. Oh, actually they do have three links. I will have to go read them later. Interestingly, the first commenter says a probiotic enema may be necessary after a c.diff infection.

    What makes Florastor special. I know you have mentioned it to me before. I think I’m missing it’s significance?

  • Well, TBH I haven’t spent a lot of time studying it. I know that it is a yeast and not a bacterial probiotic and I know that it is designed/intended specifically for the gut as compared to a general “good all over” sort of probiotic. That’s about the sum of what I know. It has just always impressed me that it was the “go to” for the infectious disease doc who, in my imagination at least, would be the sort of guy to go for drugs always. ??

  • I have been told that enemas are actually a great way for the body to absorb nutrients but in the case where I added the herbs, I was supposed to leave the water in for longer…I think 5 or 10 minutes..which would not be doable on a regular basis. We leave the water in for 2 minutes with the cone and the peristeen presenter said that the balloon deflates right after the water goes in–no more than 30 seconds or so.

  • A local SB group recently had a thread going about the peristeen and I thought I would share a new perspective. One of our local doctors does not want to advocate it and his thinking is that the cone is adjustable in the sense that you only insert as far as in natural/comfortable. However, since the peristeen has an inflatable balloon, it could cause stretching to the sphincter and decreased tone by too much forcing. There are no long term studies on its effects on the body. From what I have heard it is more effective than the cone but something to consider, for sure. I’m not sure what we will decide.

  • That’s interesting. I thought it was actually inflated a little beyond the actual sphincter, no?

    If you already have so little tone that you have no control… Does it matter? If it takes you from a loss of say, 75% or 80% to 85% or 90%, does that have any practical implication in someone’s day to day? It’s isn’t as if we are talking about losing continence. Or do I misunderstand something?

    One of the things that concerns me about an enema is that it’s seems I think would be so much more challenging to self administer. That and they don’t seem to flush as far and so don’t provide as much relief from accident. To me that has more practical, long term consequence than overall sphincter cobtrol. The social/psychological aspect of this whole process seems at least as significant as the medical, maybe more in some circumstances. I mean, who wants to be 15 or 25 or more and have to have someone help you use an enema or always worry about leaks.

    I don’t know. Maybe I really am overlooking something. Maybe giving yourself an enema isn’t as tricky or messy as I imagine. But from what I’ve read, people who’ve switched saw a very big improvement in how they go about their daily routine.

    Was there more insight that this doctor or anyone else had to offer. Had he seen in be problematic in SB patients? Were there families there who use it?

    Thank you for sharing! I wish we had a local group, but we don’t. I’m always so grateful for you ladies sharing your resources here!!

  • Yes, its inflated beyond the sphincter but I can see how it would apply pressure/potentially stretch.

    The doctor is our SB ped but I have not personally talked to him about it–plan to next appt. He has concern for the long term effects but to my knowledge has not seen those effects yet. The families who are using are very happy with it.

    I am in agreement with you about social vs. medical. Absolutely. If it was peristeen or nothing. Absolutely peristeen. However, we have a good (but not perfect) system with the cone and I want to make sure we can’t just make slight adjustments to make it more reliable.

    Regarding sphincter control: I do think any amount could actually effect every day life. Even with a great system like the peristeen there can still be stomach upsets, etc and control would be very helpful.

  • That’s really very interesting. I’ll be very curious to see what he says when you talk to him.

    As far as the other goes, I am, of course, just thinking about Z. While she may technically have some small response she really has zero sphincter control. None. It’s another reason I’m a little cautious about working on softer stools. I fear we would be back in newborn diaper rash territory.

    I’ll definitely be doing something more reading though, and expect more will be known in a couple years as well.
    Kinda of odd because digestion wise, every thing seems to work pretty well up until then end, literally.

  • Following this thread too! I described Meredith’s whole bowel stuff on the other thread. But I did want to mention this. Cincinnati taught us enemas with a balloon catheter (a big Foley). I still am not clear on the preference of a cone vs. balloon, but whathave you. Anyway, in the training they mentioned that a typical kid would need 20 to 30 cc’s of air to inflate the balloon and keep it lodged in the rectum. Meredith can take over 60 cc’s of air in her balloon. Anything under 50 and it pops right back out due to such low sphincter tone.

    I am seriously considering going back to Cincy when she 8 (which is the age they recommend starting peristeen) for the whole program over again. I found it that helpful.

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