• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

Proctoclysis (rectal infusion of hydration) for increasing blood volume instead of IV saline

Sasha

Fine, thank you
Messages
17,863
Location
UK
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:
 

Never Give Up

Collecting improvements, until there's a cure.
Messages
971
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.;)
 

Sasha

Fine, thank you
Messages
17,863
Location
UK
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.;)

:(
 

Hip

Senior Member
Messages
17,824
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,

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:

Never Give Up

Collecting improvements, until there's a cure.
Messages
971
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.
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.
 

Kati

Patient in training
Messages
5,497
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.
Fleet enema is for constipation, definitely not for hydration. this said
I am not sure I am supporting rectal administration of fluids.
 

Hip

Senior Member
Messages
17,824
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:
Many POTS patients, including the author of this article, have reported a substantial improvement in the quality of their life and a lessening of their POTS symptoms after receiving IV saline. Patients share stories of being brought into the ER by ambulance, unable to walk and extremely lightheaded, and after receiving 1-2 liters of normal saline, being able to walk out of the ER feeling pretty good and drive themselves to the store to run some errands. While this is a very subjective description, many patients share similar stories.
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:
rectal fluid infusion does not require sterile fluids, special equipment or complex training (Girisgin et al 2006).
The Girisgin paper mentioned above is here.



The proctoclysis study also says:
In a study by Bruera et al (1994), it was demonstrated that proctoclysis with tap water or 0.9% sodium chloride at rates of between 100-400 ml per hour was a safe, effective and low-cost technique for delivering hydrating fluids for two weeks or more in terminally ill cancer patients.

In this study, 78 patients received either tap water or 0.9% sodium chloride via a nasogastric tube inserted 40 cm into the rectum. Four patients declined to continue treatment because of discomfort, and nine experienced an enema effect (bowel movement as a result of the fluid infusion). In most patients, hydration was well maintained and there were no reported side effects or complications.
The Bruera paper mentioned above is here.
 
Last edited:

Hip

Senior Member
Messages
17,824
@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.

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.
 

Hip

Senior Member
Messages
17,824
I just found these cautions about the risks of IV saline for POTS:
Recently, there have been reports of patients having regular saline infusions, typically 1 liter of normal saline every other day or every day. Many report an improvement in symptoms. However, there are not yet objective data to substantiate such benefit. Further, there is a risk of vascular access complications or infection.
Source: here.

All specialists on the panel advised strongly against intravenous saline to treat PoTS (except in an emergency) and have seen severe complications of regular intravenous therapy. ‘It’s not a case of if, but when’
Source: here.
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:
If you drink water on an empty stomach, it can pass through the stomach into the large intestine and enter your bloodstream within 5 minutes (especially if the water is colder, compared to warm!). But, if you’re eating while drinking the water, you may have to wait upwards of 45 minutes before the water is passed into the intestines because the stomach must digest the food first. Overall, on average, it takes from 5 minutes to a total of 120 minutes for water to fully absorb into your bloodstream from the time of drinking.
 

Sasha

Fine, thank you
Messages
17,863
Location
UK
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.

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

Hip said:
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.

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.
 

Hip

Senior Member
Messages
17,824
I don't even know why it's better to have saline than just to drink loads of salted water.

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.
 

IreneF

Senior Member
Messages
1,552
Location
San Francisco
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:

Hip

Senior Member
Messages
17,824
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.

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.
 

IreneF

Senior Member
Messages
1,552
Location
San Francisco
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.
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: