Living with VACTERL Association

Useful Tips for Bowel Washouts (Transanal Irrigation)

Be Kind To Yourself. Bowel care can be uncomfortable, painful and distressing.
Listen to your body - take your time

Careful planning:
Drink plenty of water throughout the day to prevent constipation.
Try to keep a consistent routine, your bowel responds well to regular timing.
Eating or drinking 20–30 minutes beforehand can help activate the bowel.
Warm drinks such as tea or coffee may stimulate bowel movement.
Gather all equipment before starting to avoid interruptions

Equipment & Setup:
Check all equipment is clean and working properly.
Have the right equipment - Long tubing can improve positioning and comfort.
Prepare the recommended volume for your specific need.
Filling washout bag via the tap can be tricky.
Use a jug to transfer water into the bag. Use lukewarm water.

Too cold → cramping
Too hot → risk of irritation / injury to bowel lining.

 

Hang the irrigation bag at the correct height to allow a steady flow.

Remove air from tubing before inserting catheter.
Lubricate the rectal catheter well to prevent discomfort or injury.
Hang the bag at the correct height for steady flow.

Relaxation and correct positioning help:
Good posture makes a big difference
Sit upright on the toilet, leaning slightly forward.
Keep feet supported (use a small stool if needed).
Avoid slouching as this slows bowel emptying.
Stay relaxed—tension can stop the bowel working properly.
This mimics the natural squatting position and helps emptying.

During Irrigation:
Pump slowly and steadily. - do not rush.
If you feel pain or cramping, stop briefly and allow bowel to relax.
Mild fullness is normal; sharp pain is not.
Allow a few seconds between pumps to reduce discomfort.
Slow pumping helps water travel higher into the colon.

Waiting & Emptying:
Avoid rushing, this is one of the main causes of leaks later.
Relaxation helps the bowel work more effectively.
Stay seated long enough for complete bowel emptying.
Emptying may take 30–60 minutes depending on the system.

Breathing techniques to help you poo:
Breathe normally.
Push into your waist and lower tummy.
Expand your tummy like a balloon.
This pushes the poo from the rectum into the back passage (anus).
Gentle movement or shifting position may help stimulate bowel activity.
Lean side to side.
Gentle tummy massage.
Standing briefly then sitting again.
Deep breathing.
If you don’t sit long enough you may get leakage on the floor, staining of underwear and trapped gas - tummy colic pains.

If water flows out immediately, possible causes include:
Catheter not inserted correctly.
Balloon not inflated properly (if applicable).
Muscle tension.

Comfort & Practical Tips:
Wear comfortable clothing.
A blanket/fleece over your knees provides warmth and comfort.
Keep a table nearby for distractions (phone, book, etc.)
Puppy pads or incontinence sheets can protect flooring.
Allow enough time so you don’t feel rushed.
Take your time—do not your rush bowel care.
Watch for signs your bowel routine is changing.
Leakage may mean you need to sit longer.
Walking gently may help if the bowel feels sluggish.
If you sit too long you may get pins and needles in your feet.

Hygiene & Aftercare:
Clean yourself gently and thoroughly after bowel care.
Wipes & scented disposable bags are available from some bowel care companies.
Wash and dry equipment after each use.
Hooks in bathroom are useful to hang washout bags upside down to dry.
Towels can be used if you need to lie on the floor to insert the enema tube, but this adds to the need for extra washing.
Clean area thoroughly - sometimes the washout  sprays poo under toilet seat.

Lifestyle & Diet:
Know the foods/drinks which suit you.
Whenever possible stick to those.
Maintain a balanced diet with fibre, fruit, and vegetables.
Drink enough fluids daily.
Exercise regularly to stimulate bowel function.
Learn which foods help or worsen your bowel symptoms.

Signs Your Routine May Need Adjustment:
Speak to a healthcare professional if you notice:

• Frequent leakage.

• Persistent constipation.

• Pain during irrigation.

• Bleeding.

• Increasing time required for emptying.

• Ineffective washouts.

Diet & Lifestyle:
Understand why a balanced diet is important.
Do certain foods cause constipation? Give you tummy cramps / colic? Make the stools very loose? Generate lots of gas / flatus?
Gas-producing foods (varies individually).
Exercise is extremely beneficial—even light walking helps bowel movement.

Helpful foods:
Fruits. Vegetables. Whole grains. Adequate fibre and fluids.
Be cautious with foods that may worsen symptoms:

• Excess dairy (for some people)

• Highly processed foods

• Low fluid intake

Emotional Wellbeing:
Bowel care can be physically and emotionally draining. 
Some helpful coping strategies:
Plan enough time so you don’t feel rushed.
Comfortable environment.
Use distractions (music, phone, reading).
Keep supplies easily accessible.
Be patient with your body.

Tell people where you are going as you may be in the bathroom for some time.

Further information can be found here:
https://www.bbuk.org.uk/tips-for-effective-transanal-irrigation/