Clinical Application of Continent Anal Plug in Bed-Ridden Patient with Intractable Diarrhea

ABSTRACT

Poor control of bowel movement in some bed-ridden patients with various causes such as stroke or spinal cord injury which causes fecal leakage and diarrhea, increases the risk of perianal excoriation, bed sores and is a burden on caregivers. PURPOSE: To evaluate the efficacy of fecal evacuation, prevention and treatment of skin complications in intractable diarrhea patients employing a new device. METHODS: A continent anal plug (CAP US Patent No. 5,569,216 Join Ent. Seoul, Korea) comprises an inner balloon surrounded by an external balloon both of which are mounted on a silicone tube containing a pair of air passages and an enema fluid inlet. The tube is secured in place in the rectum by the inflatable external balloon and is designed to drain fecal matter through a thin collapsible hose situated in the anal canal. Thirty two patients (21 male, median age 61 years, range; 28~76) were evaluated after fully informed consent. Median duration (range) was 12 (3~37) days. RESULTS: CAP evacuated efficiently in those with loose or watery stools who only required once daily irrigation or not. Skin excoriations improved in 3~7 days. Minimal leakage was seen around the anus. There was no anorectal mucosal injury noted over 37 days. Conclusions: The CAP was an efficient method of treating patients with loss of bowel control and incontinence because it enabled controlled fecal evacuation and helped reduction of skin complications without causing anorectal mucosal injury.