The 12th Invest in ME Research Conference June, 2017, Part 2
MEMum presents the second article in a series of three about the recent 12th Invest In ME International Conference (IIMEC12) in London.
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Proctoclysis (rectal infusion of hydration) for increasing blood volume instead of IV saline

Discussion in 'Problems Standing: Orthostatic Intolerance; POTS' started by Sasha, Nov 16, 2015.

  1. Sasha

    Sasha Fine, thank you

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    Just reading about this in a paper about OI - the guy is talking about the risks from a PICC line and is speculating that proctolysis might offer an alternative because you can do it at home.

    This article talks about proctolysis in an emergency setting:

    http://www.researchgate.net/publication/38036037_Proctoclysis_emergency_rectal_fluid_infusion

    Wondering about this as an OI treatment. I might be asking about IV saline and if they refuse because of infection risks I'll ask about this.

    Anybody tried it?

    Dignity out the window long since, obv. :cool:
     
  2. worldbackwards

    worldbackwards A unique snowflake

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    My more embarrassing symptoms have long since eased off, but still, solidarity sister!
     
  3. Sasha

    Sasha Fine, thank you

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    I thought you'd be posting about proctolysis and had just been thinking how appropriate your user name was! :eek:
     
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  4. Never Give Up

    Never Give Up Collecting improvements, until there's a cure.

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    Seems like it would have many, many negative effects as an ongoing treatment. Diarrhea, risk of infection, risk of rectal perforation, changing the flora, possibly damaging the all important anal sphincter, plus, it's poopy.;)
     
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  5. Sasha

    Sasha Fine, thank you

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    :(
     
  6. ahmo

    ahmo Senior Member

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    Any idea how this differs from an enema? Is it going in much slower?
     
  7. Sasha

    Sasha Fine, thank you

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    No idea!
     
  8. Hip

    Hip Senior Member

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    Where did you get this list of side effects from? Or did you just make it up? Seems a bit negative to concoct side effects that we don't even know occur.
     
    Last edited: Nov 16, 2015
  9. Never Give Up

    Never Give Up Collecting improvements, until there's a cure.

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    I am remembering the litany of warnings in pre-procedure consent forms and saline enema packaging that I have read for myself and loved ones over the years, as well as many conversations I've had with physicians about all kinds of GI issues, testing, and treatments. I looked a few up for you:

    http://www.drugs.com/cdi/fleet-enema.html

    Possible side effects of Fleet(saline) enema:

    All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

    BLOATING; DIARRHEA; GAS; NAUSEA; STOMACH CRAMPS.

    Seek medical attention right away if any of these SEVERE side effects occur:
    Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); DIZZINESS; failure to have a bowel movement within 6 to 8 hours after using Fleet enema; FAINTING; MUSCLE CRAMPS OR PAIN; RECTAL BLEEDIN; SWELLING, PAIN, OR IRRITATION; WEAKNESS.

    http://www.mayoclinic.org/tests-procedures/barium-enema/basics/risks/prc-20019174

    Risks
    By Mayo Clinic Staff

    A barium enema exam poses few risks. Rarely, complications of a barium enema exam may include:

    INFLAMATION IN TISSUES SURROUNDING THE COLON
    OBSTRUCTION IN THE GASTROINTESTINAL TRACT
    TEAR IN THE COLON WALL
    ALLERGIC REACTION TO BARIUM

    I'm stopping here, but I have been warned by physicians of all of the things I listed above.
     
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  10. Kati

    Kati Patient in training

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    Fleet enema is for constipation, definitely not for hydration. this said
    I am not sure I am supporting rectal administration of fluids.
     
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  11. Sasha

    Sasha Fine, thank you

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    To be clear, nor am I - I'm just asking about it!
     
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  12. Hip

    Hip Senior Member

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    I would think there is great potential for this proctoclysis rectal saline infusion for POTS (postural orthostatic tachycardia syndrome) patients, and for any ME/CFS patients with low blood volume.

    From the potsgrrl blog:
    So we know IV saline is pretty effective for POTS, but the trouble with IV saline is that it requires a hospital visit every few days and trained hospital staff. Whereas I would think that the proctoclysis alternative could be performed by patients themselves at home with very simple equipment.

    The proctoclysis study says:
    The Girisgin paper mentioned above is here.



    The proctoclysis study also says:
    The Bruera paper mentioned above is here.
     
    Last edited: Nov 17, 2015
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  13. ahmo

    ahmo Senior Member

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    @Hip I read the description, it refers to catheter. Can you work out what makes this different than using an enema set-up for the same application? thx.
     
  14. Hip

    Hip Senior Member

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    In the description they refer to a Foley catheter, which has a tiny inflatable balloon that I believe prevents the catheter from slipping out of the rectum, and I guess also acts to hold the fluids within the rectum.

    However, if you push an ordinary thin tube far enough into the rectum, it will probably hold itself in.

    Also, I think the difference between proctoclysis rectal saline infusion and an enema is that in the former, the saline is introduced slowly (they mention 100 to 400 ml of saline per hour for proctoclysis).


    If anyone wants to make up their own physiological solution (0.9% saline), by the way, you simply add 9 grams of sodium chloride to 1000 ml of water.
     
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  15. Hip

    Hip Senior Member

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    I just found these cautions about the risks of IV saline for POTS:
    In the second quote above, they don't mention the nature of the complications, but it may again be the vascular access or infection complications. In which case, this might provide a good argument for proctoclysis as an alternative to IV saline.



    Would anyone know what the advantages are of proctoclysis, versus just drinking more water (saline water if necessary)?

    Is water or saline more easily absorbed into the bloodstream by rectal administration, compared to drinking? I read that when drinking, water is absorbed in stomach, and then the small and large intestines.

    One article said:
     
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  16. Sasha

    Sasha Fine, thank you

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    It was the mention of these risks of IV saline (but also the benefits) by Dr David Bell that made me wonder about proctoclysis.

    Excellent question - but I don't even know why it's better to have saline than just to drink loads of salted water.

    Do you know, @Jonathan Edwards?

    Not contemplating DIY, by the way - I want to discuss this with my cardiologist if it looks like an option but want to go genned up so I don't get laughed out.
     
  17. Hip

    Hip Senior Member

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    Presumably IV saline guarantees increased blood volume for a day ot two, whereas drinking more water may not; but I am unsure as to why.


    An interesting article on how the kidneys regulate blood volume is found here. It says that angiotensin II and aldosterone act in the kidneys to increase sodium retention and fluid retention.

    This is one reason why fludrocortisone, an aldosterone analogue, helps POTS (the other apparently is that fludrocortisone sensitizes the blood vessels to constriction 1).

    Antidiuretic hormone is also involved in kidney fluid retention, and this study found that desmopressin, an antidiuretic hormone analogue drug, helps POTS significantly.
     
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  18. IreneF

    IreneF Senior Member

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    In my experience, iv fluids make you pee about as much as drinking. So I don't see any advantage to rectal administration or infusion over drinking, esp. when drinking is easy and generally safe.

    About 1/2 tsp of salt per quart of water helps the body retain fluid. I used to drink about 2 quarts of saltwater a day, but didn't find it helped me exercise or tolerate heat.
     
    Last edited: Nov 17, 2015
  19. Hip

    Hip Senior Member

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    Not saying you are wrong, but then it seems crazy that POTS patients would go to all the trouble of getting an IV infusion of a liter of saline, when they could have just drunk the same amount of liquid at home.

    But perhaps as you hint at, drinking physiological solution (which has 9 grams of sodium chloride per liter — the same as the blood) is a way to help the body retain the fluid that you drink.
     
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  20. IreneF

    IreneF Senior Member

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    I don't know why they need infusions, unless drinking is not fast enough, although I can drink a liter of water in less time than it takes to infuse. I guess it's because it takes a variable amount of time for fluid enter the bloodstream, and they need rehydration quickly. I just remember dragging my iv pole into the restroom more frequently than I wanted to.

    Your kidneys and hormonal system are working all the time to normalize your fluid balance. Does it matter how the fluid enters your body?

    The problem with chronic hypovolemia is that your new normal is set too low, so you need to salt load or take antidiuretic hormones to compensate. It just wasn't enough for me.
     
    Last edited: Nov 17, 2015

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