Antegrade continence enema (ACE): Irrigation

What is antegrade continence enema irrigation?

Commonly known as ACE irrigation, this procedure causes a bowel movement by flushing the bowel with liquid. Normal saline (a salt-water solution) is given through a catheter in the ACE stoma. A bowel movement through the rectum follows about 30 to 60 minutes later. This procedure is done on a regular basis—usually daily—to prevent constipation or stool accidents.

Your doctor or nurse specialist will tell you when to start irrigating your ACE, usually between 5 and 10 days after the stoma surgery was done.

How do we prepare for the irrigations?

At first, you will irrigate daily using the catheter that was placed in your child's stoma during surgery. You will gradually increase the amount of normal saline used to flush the bowel. Over time, you will find the right amount of saline and the right schedule for your child. Some need to do an irrigation every day, and some do it every other day. You will find what works best for a good bowel movement with no stool accidents.

Pick a time for the irrigation that works with your schedule, so you are not rushed. If possible, try to do the irrigation at the same time every day. Soon irrigations will become a normal part of your daily life.

At an appointment a few weeks after surgery, the catheter will be taken out. The doctor or a nurse will teach you and your child how to pass a catheter into the stoma each time you irrigate, and you will get a prescription for catheters to fit the stoma.

Making the normal saline

Buy distilled water at the grocery store or pharmacy. To one gallon of distilled water, add 8 level measuring teaspoons of table salt. Shake well to dissolve the salt. Store at room temperature.

How should I do the irrigations?

A nurse will teach you how to do the first irrigation. You will start with a small amount of saline. Over about a month, you will gradually increase the amount until you have a good result and no or few stool accidents between irrigations. See the schedule of amounts on the next page.

1. Gather equipment:
   • normal saline in a container with a spout 
   • to give amounts less than 200 ml, use a 60 ml catheter tip syringe
   • to give 200 ml or more, use an enema set or feeding bag
2. Prepare the correct amount of saline for the enema:
   • draw it up into the syringe, or 
   • pour it into an enema set or feeding bag and run it to the end of the tubing to push the air out. (Air in the bowel will cause gas and cramping.)
3. Have your child sit on the toilet.
4. Catheterize the stoma, if not already done.
5. Insert the tip of the syringe or bag tubing into the catheter.
6. Give the saline slowly. Giving it too quickly may cause cramping. When using an enema set or feeding bag, the higher you hold it, the faster the saline runs. If cramping occurs, stop. When cramps stop, give the saline at a slower rate.
7. Wait for a bowel movement. The first few times you irrigate, there may be no bowel movement. You may need to continue your usual bowel program until you get to an adequate amount of saline.
8. When finished, wash your hands well using soap and warm water. Rub all surfaces of your hands briskly.

How do I care for the equipment?

1. Rinse the syringe or enema set with water.
2. Wash the catheter with antibacterial soap (such as Dial®) and warm water.
3. Rinse well with water to remove soap.
4. Air dry on a clean towel.
5. Replace the catheter every 2 weeks.

Irrigation schedule

Increase the amount of saline by 50 ml every 3 days until you have good results: a good bowel movement with no accidents between irrigations.

Date	Amount	Date	Amount
	50 ml		300 ml
	50 ml		300 ml
	50 ml		300 ml
	100 ml		350 ml
	100 ml		350 ml
	100 ml		350 ml
	150 ml		400 ml
	150 ml		400 ml
	150 ml		400 ml
	200 ml		450 ml
	200 ml		450 ml
	200 ml		450 ml
	250 ml		500 ml
	250 ml		500 ml
	250 ml		500 ml

When should I call the clinic?

• you cannot pass a catheter into the stoma you cannot irrigate the stoma
• you cannot determine the right amount of saline to use
• you have reached a saline amount of 500 ml without good results

Questions?

This is not specific to your child but provides general information. If you have any questions, please call your clinic.

Reviewed 7/2017

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