Bowel washout

This resource has information about how to do a bowel washout for your baby who has been diagnosed with Hirschsprung’s disease.

Why does my baby need bowel washouts?

Your baby has been diagnosed with Hirschsprung’s disease and is unable to empty their bowel adequately without help.

Hirschsprung’s is a disease of the bowel where some nerve cells are missing. Without these nerve cells, the bowel is unable to move the poo and gas through the bowel. This will make your baby constipated and prone to bowel infections.

Cleaning and clearing your baby’s bowel with washouts lets them feel well, comfortable, and feed and grow better.

The bowel washouts will help to prevent problems and prepare your baby for their operation.

A bowel washout must only be done if advised by your baby’s doctor . You will be taught by nursing staff how to do this.

What are bowel washouts?

A bowel washout means emptying and cleaning the lower bowel using a special tube (catheter) and saline fluid. A bowel washout involves passing a small tube into your baby’s bottom and up into their bowel. The saline solution flushes out the poo from the the bowel.

Where should I do the bowel washout?

This can be done wherever is suitable and safe for you and your baby. The environment must be warm and draught free. The washouts can be done on a changing mat on a table or chest of drawers or, on a changing table.

Your baby must be supervised at all times.

What do I need?

For a bowel washout, you will need:

• changing mat and towel
• incontinence sheets (these are supplied by the hospital)
• jug or bowl to warm your bottle of saline in
• 1 litre bottle of saline (0.9% sodium chloride)
• bowl to collect the poo and saline in
• tube (catheter) (this is supplied by the hospital)
• 60ml bladder syringe (this is supplied by the hospital)
• lubricating gel (this is supplied by the hospital)
• apron and gloves if you wish to wear them (this is supplied by the hospital)
• clean nappy and items to wash your baby afterwards

You will also need someone else to help you.

How do I do the bowel washout?

1. Once you have all the items you need for the bowel washout, wash your hands and put on protective items (apron and gloves) if you wish to wear them.
2. Warm the saline in hot water in the jug or bowl. The saline should be feel warm to touch, but not hot or cold.
3. Undress your baby. You can leave them in a vest or T-shirt, or swaddle their top half in a towel. Look at your baby’s tummy and gently feel it. Often your baby’s tummy will be swollen before the washout is done. This swelling should go down when the poo and gas from your baby’s bowel is released during the bowel washout. If it is still swollen after the washout, please contact the Neonatal Surgical unit (NSU).
4. Lay your baby on top of a towel and incontinence sheet. They can lie on their left side, or on their back with their legs raised.
5. Lubricate the end of the tube with lubricating jelly and gently insert into your baby’s bottom and push the tube gently into the bowel. Push the tube as far as possible until it no longer goes up easily.
6. If the tube does not go up easily when you first put it in your baby’s bottom, gently syringe up to 20mls of the warmed saline in to open up the bowel.
7. Begin the bowel washout by filling the syringe barrel with 15mls to 20mls saline and gently syringing it into the bowel, as the nurses should have shown you. There should be no resistance.
8. Once the saline has entered the bowel, disconnect the syringe from the tube and lower the tube towards the bowl, allowing the poo and fluid to flow freely into it. This process should then be repeated gently and slowly.
9. When the fluid runs out of the tube turns clear, gradually pull out around 5cm of the tube and repeat the process. Continue slowly and gently down the bowel. At each point, make sure that the fluid runs clear before you withdraw the tube.
10. Throughout the procedure monitor your baby’s tummy and how happy they are. Also, look at the poo to see if it is different from usual. If your baby appears unwell, unduly distressed, cool or you have any concerns, stop the procedure and contact NSU for advice. If the poo is offensive smelling, unusual colour, has changed in consistency or has blood in it contact NSU for advice.
11. When the bowel washout is finished, recheck your baby’s tummy then clean, dry, and dress your baby.
12. Check the poo and fluid that has drained out and check it is a similar amount that has been put in.
13. Empty the bowl down the toilet and flush away.
14. Wash the bowl and jug with soapy water and dispose of all other items safely.

Bowel washouts must be done daily until your baby has had their surgery. No changes must be made unless advised by your baby’s surgeon.

What to do if there is a problem?

If you at any time have any concerns about your baby or the bowel washouts, please contact NSU, as detailed below.

A possible complication of Hirschsprung’s is enterocolitis. If this is left untreated, it could result in your baby becoming extremely unwell. There are several signs which should alert you to the fact that your baby might be developing this complication:

• tummy getting bigger (distension)
• not feeding well
• being sick, especially if it is green
• high temperature
• generally unsettled and drawing their legs up (indicating tummy pain)

There is also a very low risk that a bowel perforation (small hole in the bowel wall) may happen.  The signs of this complication are the same as above.

Please contact NSU if your baby has any of these symptoms or if you are worried at any point.

If your baby becomes very unwell or their condition changes immediately call 999 or take them to the nearest Emergency Department. Give the medical professional the Hirschsprung’s information card and discharge summary you will have been given.

Troubleshooting

Swollen tummy

If after doing the washout your baby’s tummy remains swollen, contact NSU if your baby is well. If your baby is unwell call 999 or take to local Emergency Department.

Cannot insert the tube

If you are unable to insert the tube into the baby’s bottom or there is resistance, do not use force when pushing the tube in. This can damage the lining of the bowel. Try:

• changing the position of your baby, laying them on their left side or back
• to gently syringe 10mls to 15mls of saline in if you are able to. This may loosen any poo that may be blocking the tube insertion
• rotating the tube gently whilst putting it in

If these do not help, clean and dress your baby and try again 30 minutes later.

If you have tried all of the above and it is still not working, contact the NSU for advice.

Difficulty syringing the saline

If you are having resistance when syringing the saline, immediately stop, and pull back the tube back around 5cm and try again. Do not insert saline into the bowel under pressure.

The tube may be blocked with poo, remove the tube from your baby and check the end for a blockage. Flush the tube with saline whilst out of the baby to clear the blockage.

If the problems continue, contact NSU for advice.

No poo comes out

If the washout does not flush out any poo, you may have to repeat the washout in a few hours. If your baby’s tummy remains swollen or they are being sick you must seek immediate medical advice by contacting NSU.

Blood

If your child is bleeding from their bottom or has blood in their poo, the tube may have irritated the lining the bowel. If there is only a small amount of blood you do not need to do anything. If the bleeding continues or there is a lot of blood, seek medical advice by contacting NSU.

Poo without washout

If your baby has managed to pass poo without a bowel washout, still continue with daily washouts. Do not miss a daily bowel washout.

Saline not draining out

If the saline which you inserted by the syringe is not draining back out. Stop the bowel washout. Some fluid or poo should drain out each time. Contact the NSU for advice.

Difficulty pulling out the tube

If you are having difficulty pulling out the tube, try to slowly, gently, rotate the tube as you pull it out. Do not pull forcefully. Contact NSU for advice.

Unusual poo

If your baby’s poo is offensive smelling, an unusual colour, or has changed in consistency, finish the bowel washout if you are able to. Save a sample of the poo and contact the NSU for advice.

What are the contact numbers?

If you have any issues call NSU on 0114 271 7324 or 0114 271 7705 and ask to speak to a member of the continuing care team or the nurse in charge. They may advise you directly or contact the surgeons and ring you back.

If your baby’s condition dramatically deteriorates you should ring 999 or take them to the nearest Emergency Department.

What support can we expect?

You will be visited at home by a member of the NSU continuing care team within 48 hours of your baby’s discharge to watch you do a bowel washout and provide support.

You will have a minimum of a weekly review at home and also a weekly phone call.

You can contact NSU on the numbers listed above at any time, day or night.

Your GP and Health Visitor will be aware of your baby’s discharge from hospital. Please make sure that you have registered your baby at the GP before they are discharged.

Your baby will have a follow up outpatient appointment with their surgeon at Sheffield Children’s Hospital to review how your baby is doing and discuss further management.

What supplies are supplied?

We will supply the following equipment that you need for the bowel washouts:

• tubes (catheters)
• syringes
• lubricating jelly
• saline (0.9% sodium chloride)
• incontinence Pads
• gloves and aprons (if requested)

You will need to provide a jug, bowl and towels.