Antegrade Continence Enema (ACE) Irrigation Schedule

Your provider or nurse will tell you when to begin your irrigations and teach you how to do it.  

We recommend that you sit on the toilet during irrigation. However, there may be no stool for the first few times you irrigate.  

• Stool accidents may occur until you decide the right amount of irrigation for you.  Each person is different.  Some people need to irrigate daily while others will need to irrigate every other day. 
• The catheter that was placed during your surgery will be removed about 3 weeks after surgery.  At this time, you will learn how to catheterize your ACE with a straight catheter.  After the catheter is removed, you will have to insert and remove a catheter each time you irrigate. 
• As you learn what works best for you, this procedure will become a simple part of your daily life.  Pick a time of day to do your irrigations that will work with your schedule, preferably at the same time every day.  Make sure you choose a time when you won’t be rushed. 
• If you experience constipation, it may be helpful to put 15-30 ml of mineral oil into the ACE using a catheter, just before doing the irrigation.  You may still need to control your diet and/or use some medicines to soften or add bulk to your stool.

There are 2 methods of irrigation. The first is with a syringe:

Supplies: 

• Irrigation solutions 
• Catheter 
• Lubricant 
• 60ml Catheter-tipped Syringe 

1.  Gather equipment 
2.  Wash your hands with soap and water and dry them thoroughly. Apply gloves if needed. 
3.  Mix irrigation solution per orders from healthcare provider. 
4.  Draw the irrigation solution into a catheter-tipped syringe. 
5.  Apply lubricant to catheter and insert clean catheter into the ACE stoma. 
6.  Connect the syringe into the fitting on the catheter. 
7.  Slowly push the irrigation into your ACE catheter. (Note: Rapid irrigations may cause cramping. Cramping and gas may also occur if air gets into the bowel. If you experience cramping, slow down the irrigation and make sure the solution is not too cold.) 
8.  Remove the catheter from the ACE stoma. 
9.  Wait for the irrigation results to occur (30-40 minutes).  Massaging the abdomen firmly from left to right may help the bowel move faster. 
10.  Rinse the syringe and catheter with warm tap water, and then wash it with antibacterial soap and hot water. Allow both items to air dry before storing them. 
11.  DO NOT discard the syringe. 
12.  DO NOT use any solvents such as alcohol or acetone to clean the syringe. 
13.  Replace the catheters every one to two weeks.

The second option for ACE irrigation is to use a gravity bag.

Supplies: 

• Irrigation solution 
• Catheter 
• Lubricant 
• Gravity bag set up 

1.  Gather the supplies.
2.  Wash your hands with soap and water and dry them thoroughly. Apply gloves if needed. 
3.  Mix the irrigation solution according to orders from your healthcare provider.
4.  Close the clamp on the gravity bag tubing and add the prescribed amount of irrigation solution to the gravity bag. 
5.  Apply lubricant to the catheter and insert the clean catheter into the ACE stoma.
6.  Connect the catheter into the fitting on the gravity bag. 
7.  Open the clamp and allow the irrigation solution to run in. (Note: Rapid irrigations may cause cramping. Cramping and gas may also occur if air gets into the bowel. If you experience cramping, slow down the irrigation and make sure the solution is not too cold.) 
8.  Once the entire irrigation solution bag is empty, close the clamp.  
9.  Disconnect the irrigation system.  Remove the catheter from the ACE stoma. 
10.  Wait for the irrigation results to occur (30-40 minutes).  Massaging the abdomen firmly from left to right may help the bowel move faster. 
11.  Rinse the gravity bag well with warm water and wash it with soap and water. Allow the gravity bag to air dry before storing it. 
12.  Immediately after using the connecting tube, rinse it with warm tap water, then wash it with antibacterial soap and hot water. 
13.  DO NOT discard the connecting tubing. 
14.  DO NOT use any solvents such as alcohol or acetone to clean the tubing. 
15.  Replace the catheters every one to two weeks.

Use normal saline (see the recipe below) or a solution recommended by your provider.  Increase the amount by 50 ml every 3 days.  

Day 1 = 50 ml  

Day 2 = 50 ml 

Day 3 = 50 ml 

Day 4 = 100 ml 

Day 5 = 100 ml 

Day 6 = 100 ml 

Day 7 = 150 ml 

Day 8 = 150 ml 

Day 9 = 150 ml 

Day 10 = 200 ml 

Day 11 = 200 ml 

Day 12 = 200 ml 

Day 13 = 250 ml 

Day 14 = 250 ml 

Day 15 = 250 ml  

Day 16 = 300ml 

Day 17 = 300 ml 

Day 18 = 300 ml 

Day 19 = 350 ml 

Day 20 = 350 ml 

Day 21 = 350 ml 

Day 22 = 400 ml 

Day 23 = 400 ml 

Day 24 = 400 ml 

Day 25 = 450 ml (Increase by 50 ml every 3 days until you have good stool results.) 

Option One: 

• Mix 1 gallon of distilled water with 8 teaspoons of table salt. 
• Shake the container until the salt is dissolved. 

Option Two: 

• Boil 2 quarts of tap water for 10 minutes. 
• Add 4 teaspoons of table salt to the boiled water. 
• After the saline cools, pour it into a clean plastic bottle and store it.