US2832341A - Method of giving peristaltic enemas - Google Patents

Description

April 1958 M. E. STACK 2,832,341

METHOD 0]? arms PERISTALTIQ ENEMAS Original Filed April 17, 1950 s Sheets-Sheet i MARY IE. STACK INVENTOR ATTORNEYS April 29, 1958 M. E. STACK 2, 32,

METHOD OF GIVING PERISTALTIC ENEMAS Original Filed April 17, 1950 3 Sheets-Sheet 2 INVENTOR ATTORNEYS April 29, 1958 M. E. STACK METHOD OF" GIVING PERISTALTIC ENEMAS Original Filed mu 1?, 1950 3 Sheets-Sheet 3 MARY E. STAQK :NvEN'roR ATTGRNEYS ment has been completed.

nited States Original application April 17, 1950, Serial No. 156,3ti5, now Patent No. 2,6ll6,557, dated August 12, 1952. Divided and this application November 51, Serial No. 254,818

6 Claims. (Cl. 128 227) This invention consists of a method and the equipment necessary to practice the method of giving enemas through the use of the peristalsis of the bowels. in using this method, a supply flow of liquid with minimum pressure is employed. The speed and volume-of the supply flow is controlled to preclude the possibility of causing pressure on the colon, and reliance is placed upon the reflexes and impulses of the patient's bowel and colon to respond to the treatment in the use of an accumulator to store and return said liquid during contraction and expansion of the colon.

This application is divisional application of the copending application, Serial No. 156,305, filed April 17, 1950, which is a continuation-in-part of the application, Serial No. 732,302, filed March 4-, 1947, which issued as U. S. Letters Patent No. 2,538,215, dated January 16, 1951.

This method should not be confused with colon irrigation as it does not wash out the colon by forcing liquid into the colon under pressure, without regard to the impulses and reflexes of the alimentary tract, and then depend upon the washing out of the colon when the impounded water is released from the patient. In distinction to this type or" flushing, which has been so long used to reduce constipation in the human bowel,

this present type of enema contemplates introducing fluids, normally warm water, into the full length of the colon, thereby assisting nature and reducing the highly compacted material found in the colon to its more normal plastic form, so that it can be eliminated by the patient in the normal manner after this method of treat- Peristaltic action of the colon is stimulated during this process. To properly employ this method, means are provided for the introduction of warm liquid into the bowel, and, means are further provided for the control of the flow of such liquid so that the end result will be achieved without inconvenience or pain to the patient.

The enema, according to recorded history, has been used as early as 1618 for the relief of constipation in the human bowels, since that time a great many types of syringes and various instruments have been devised in an effort to improve effectiveness of the enema. However, none of these that have been observed have come into popular universal use with the exception of the ordinary enema-can technique, which has, for many years been considered standard equipment in hospitals and other medical institutions, as well as in many homes. The operations of such equipment and the method followed usually takes the form of an attempt to wash the feces from the colon by mechanical means, as a substitute for the abdominal reflexes provided by nature, and results in more or less doubtful benefits and in distress to the patient. While the ordinary enema-can technique has served very necessary and worthy purposes throughout the years, its operation and general results still leave a great deal to be desired, possibly be- 9 1C@ Patented Apr. 29, 1958 2 cause the efforts for improvement have not shown progress equal to the advance of other branches of medical science during the same period of time.

This present invention is believed to overcome many deficiencies experienced in the past and to provide at least one very practical solution of this perplexing problem. The enema given, following the teachings of this invention, is made to operate on the principle that the normal functioning of the alimentary tract should govern the injection of fluid into the rectum for the purpose of stimulating colonic muscular action, causing expulsive impulses. Further, mankind, by nature, is provided with abdominal reflexes and resulting expulsive impulses surficient for the purpose of colonic expulsion, at regular intervals under normal conditions, and it has been reasonably proved that constipation is: an abnormal condition calling for correction. However, the principles of injection of fluid into the rectum by force is, at best, an unnatural act which violates the processes set up by nature for the normal evacuation of the waste of the bowels, especially when the colon is congested with feces and heavy internal gases.

in the usual case the injection of fluid by force, may put pressure on and irritate an already extended bowel with resulting distress to the patient and possible failure to secure the desired results.

, The principal object of this present invention therefore, is to provide a method of conducting peristaltic all) enemas.

A further object of this invention is to provide a method for the conducting of peristaltic enemas in which the bowel may be considered, in effect, as though it were in series, with a source and accumulator of warm liquids which enter the colon without pressure and which stimulate nature to bring about the normal reflexes and impulses which may have reached a low functional level in the patients bowel and colon.

A further object of this invention is to provide suitable mechanical equipment so that the peristaltic enema can be given in a manner to promote and stimulate natures own methods of evacuating the bowel.

A further object of this invention is to provide a method of supplying heated liquids at controllable near zero pressures and to provide the mechanical means for controlling the flow of such fluids, as medical experience has proved to be most desirable.

Other objects include to provide a method for giving enemas to patients who have colonic conditions which do not respond to treatment by the conventional enema can method of giving enemas, and to devise a method of giving enemas which will stimulate the patients towards the end that the natural body processes of elimination will be rehabilitated so that the patient will no longer have to depend on enemas and laxatives for assistance in excretion.

Further objects, advantages and capabilities will be apparent from the description and disclosure in the drawings, or may be comprehended or are inherent in the device.

In the drawings:

Figure l is a side elevation of the equipment used in practicing the method of this present invention;

Figure 2 is a side elevation, in section, with certain parts broken away, illustrating the internal construction of this equipment;

Figure 3 is a perspective view showing the electrical means used with this equipment;

Figure 4 is an enlarged longitudinal sectional View of the nozzle used with this equipment;

Figure 5 is a cross sectional view taken along the line 5 5 of Figure 2;

Figure 6 isa perspective view showing the upper elements of the equipment used in this invention;

Figure 7 is a bracketed diagrammatic view showing the valve setting when the equipment is positioned for the otf'position, as shown in Figure 6;

Figure dis a bracketed diagrammatic view showing the valve setting whenthe handle is. set at 1;

Figure 9 is a bracketed diagrammatic view showing the valve setting when the indicating handle is set at 2;

Figure 10 is a bracketed diagrammatic view showing the valve setting when the handle is turned to 3, as indicated in-Figure 6.

Referring more particularly to the disclosure in the drawings, the numeral 12 designates the supply tank or source, and disposed adjacent it, is the return tank or accumulator 14. These tanks are normally disposed with theirtops on the same level, so that a common yoke member 16 may adequately support the same, and in turn this yoke member may be adequately supported as from the opening 18, in lugs 19. It is to be noted that the bottom 2% of tank 12 is somewhat above the bottom 21 of tank 14. Practice has indicated that the bottom 21 of tank 14 should be approximately one-third of the length of tank 12 below bottom of tank 12. This relationship is necessary to insure flow of fluid from the patient to tank 14 and prevent its flow :from the patient to tank 12 when the reflexes of the colon cause such a return flow. This distance corresponds generally to the distance between the top and bottom of the colon area of a reclining patient.

Disposed below tanks 12 and 14 is the valve assembly, generally indicated at 24. The construction of these parts will probably be best understood by reference to Figure 2, in which it will be noted that a through passage, or supply tube 26, operatively connects tank 12 and valve 24; and, likewise, a return tube 28 similarly connects tank 14 and valve 24. These connections further supply a means for joining the valve to the tanks as a useable connected unit, which in turn may be suitably supported, as by hook 30 from the U-shaped, or overhanging standard member 32. This standard has a lower portion, as 34, which is straight and adapted for sliding into fitting 35, which joins together the supporting feet 38. An adjusted position for elevation is obtained by means of the locking lever 40.

Also, coupled to valve assembly 24 is the supply line 42 and the return line 43, both of these lines uniting in nozzle 45, which is shown in detail in Figure 4. A fifth connection is made to valve 24 in that the waste line 46 is so connected to valve 24 that it can, by proper setting of the valve, discharge the waste from return can 14 into the waste tank 48.

It will be noted, particularly in Figure 6, that collapsible bulbs 50 and 51 are provided, which in turn connect with the supply pipe 42, as at 52, and with the return pipe 43, as at 53. These bulbs, which are of the usual type in which when the finger is placed over the end and the bulb squeezed, makes it possible to force a small amount of liquid through either of the pipes so that stoppages usually caused by clots or solid materials in the form of lumps, may be dislodged by the momentarily increased pressure. Stoppage normally occurs at the intake and discharge openings formed in nozzle 45, when the same is in.

use.

Valve 24 consists essentially of a housing member 56, which is bored to accept the cylinder valve member 53. A hinged cover is provided for the cylinder at 6t, and quick acting clamp means is indicated at 61, so that the unit can be very readily taken apart for cleaning and sterilization after each use. The cylinder valve 58 is preferably a solid cylinder in which are bored a plurality of radially disposed passageways. As it is believed that the construction of such a cylinder valve is well within the scope of the experience of the average mechanic, the detailsof construction are merely indicated in diagrammatic [form in Figures 7, 8, 9, and 10 where the two groups of .4 holes, one at each end of the valve, are shown in the bracketed views. The setting in Figure 7 corresponds to the handle setting to the word off, in Figure 6. In this position all ports are closed. In the next setting shown in Figure 8, which would be 1 on the dial formed on cover =59, a connection is made from the supply tank 12 to the supply tube 42, and then to the patient where discharge is made out through port 63 of nozzle 45. The return circuit is also completed so that return water or taken in the intake orifices 650i nozzle 45, then flow through tube 43 through the cylinder valve into the return tank 14. Except for this completecircuit from tank 12 to the patient and return to tank 14, all other ports are closed in the valve 24, in the setting shown in Figure 8.

in the valve setting, wherein the operating handle 67 points to setting 2 on plate 60, and this conforms to Figure 9 of the drawings, a channel is open from tank 12 to the patient through tube 42 and nozzle 45, and back from the patient through nozzle 45, tube 43, to the return tank 14. In this setting another port is opened that opens a channel from tank 14 through tubes 2. and 46 to the waste can 48, and also from the patient via tubes 43 and 46 t0 the waste can. The liquid material in the colon may thus be drained while maintaining the flow of fresh liquid. All other ports are closed.

Figure 10 shows the valve setting for position 3 of Figure 6. In this case a constrictor, as 69, is placed in a passageway of normal size within the cylinder valve- 58, so that a proctoclysis or continuous drip of from fifteen to thirty drops per minute will be achieved. This is in a restricted channel from tank 12 to the patient with a channel from the patient via tube 43 and tube 46 to the Waste can. All other ports are closed. This setting is used in cases of dehydration of the feces where a very small re-supply is desirable. The setting at 3 is miantained until peristaltic action of the colon commences whereupon the setting is changed to l normally.

It has further been found that by having a smallstricture fitting, as 69, which can be inserted in a standard, drilled through opening the cylinder valveSS, the size of the orifice can be changed to give a drip of varying amounts which can be suited to the patients' individual case.

The nozzle 45 used with this equipment is not, ineffect; a true nozzle as is normally considered wherein the elements are made of moulded hard rubber or some of thevarious plastics which are unyielding. in this instance, it has been found very desirable to provide nozzle 45 to be, in effect, two rubber tubes which are joined together, one alongside of the other; so the tubes, as a unit, can be readily inserted into the rectum or further into the colon than would be possible with the average separate nozzle arrangement which-is so often used. To produce die nozzle, after the showing of Figures 2, 4 and 5, we use material that has sufficient body so that it can be readily inserted into the colon and then possesses suficient flexibility that it can be inserted further if desired. For this purpose, the supply tube 42 terminates in a tube of reduced diameter which is merged with the nozzle portion 73 of the return tube 43.

In Figure 5 a typical cross-sectional view is shown in which passage 72 will be observed to have approximately one-third of the diameter of passage 73, and this proportion has been found to be very desirable. Passageway 72 may be small because the supply of liquid is not rapid and passageway 73 should be rather large to accommodate, with ease, thevolume of material passing between the colon and return tank 14. This cross-section should be, continued for some length of the tube or nozzle, after the showing of Figures 2 and 4, so that insertion to the desired extent can be readily achieved. discharge of tube 72 is slightly back from the closed end 74 of tube 73, so that normally, the closed end 74 will It is to be noted that the serve as a guard and normally prevent the closure of opening 63 and at the same time it performs a function of a shield which tends to direct the outgoing water or fluid in the line of prolongation of the nozzle. The intake ports 65, on the other hand, which communicate with tube 73, are spaced backwardly somewhat from end 74'. This is in part to prevent clo ot' the same, and further, to prevent a short circu of the fluid, which might occur if the how were conveniently possible from the discharge opening 63 to the intake openings 65.

Figure 3 illustrates an electric heating unit This unit is supplied by electric current as through the cable 81, and is provided with side guide rails, as 32, which are adapted to co-act with the co-acting guide rails as, formed in the bottom of the supply tank iii. A spring loaded ball or detent is provided at E55 to hold the device in place while it is in use. This device can either be thermostatically controlled, or, it can be subject to operator control and the actual temperature taken by a thermometer placed in tank 12.

Referring to Figure 1, one form of operating table has been indicated generally at $7. This equipment, normally, is provided with vertical adjustments and tilting adjustments, so that the patient can be caused to assume the most favorable position for tr atment. In Figure l, one of the most favorable positions of the patient is illustrated by dashed lines, 89, and nozzle 45 is shown substantially in the position it would occupy in the patient. Table 8'? is not a part of the peristaltic enema device.

Method of operation As the peristaltic enema is normally only properly givenunder hospital conditions, where either a trained nurse or a physician is in attendance, the method will be described and the use of the apparatus detailed, considering that the treatment is being given under such conditions. he pa tient is normally placed on his back and in such a position that the colon, as an entirety, is disposed substantially in a horizontal plane. This can be achieved by the normal positioning of the patient, as indicated in Figure l, and is well known to skilled nurses. The enema tanks are then adjusted by means of the adjustable standard so that the bottom of the supply vessel 12 is substantially on the mean level of the upper portion of the colon. This height insures gravity flow of liquid from the source of supply to the colon. This will place the return tank so that its bottom is somewhat below the level; as will be noted in the drawings, the difference in elevation of these two tanks is substantially the diameter of the average colon so that the bottom of one tank will be at the top of the circular cross-section of the colon, while the bottom of the other tank will be substantially at the bottom of the cross-section of the colon. Valve 2ais set, after the showing of Figure 8, so that a free passageway is provided from the supply tank 12 to the patient through the small supply tubes 42 and 72, and the larger return tubes 43 and are connected also by valve 2: to the bottom of the return tank Now, it is desirable to maintain this arrangement, namely, that the enema water or other fluid supplied by the enema equipment enter the anus through the small tube 72, whereas the return is through the large tube '73. The arrangement of the nozzle 45, as shown in Figure 5, will illustrate the relative proportions that have been proven as best adapted to this use. When these conditions have all been fulfilled, the device is in operating condition.

Now, inasmuch as there is no appreciable pressure, due to the insignificant head of water for the fluid in the supply tank 12, there may be a short period where there will actually be no flow of fluid. This quite often occurs, due to the natural contraction of the anus and other muscular elements of the rectum and colon, but, soon it will be noted that these muscles will become relaxed and the normal functioning of the body begins to take place. This gives the name to the method, because it is the peristalsis of the bowel which causes the flow of liquid, an arrangement as shown and described where the liquid flows into the bowel by gravity with negative pressure and is on y caused to circulate by the reflexes and impulses of patients own bowel and colon muscles. T his action is in marked contrast to the usual colon irrigation or enema in which water is introduced under pressure to actually attempt to wash out the feces from the bowel. This usual colon enema is contrary to all accepted principles of the natural functioning of the human anatomy and to the invalid patient it is painful and a most ditlicult way of achieving the desired end result. In this present method, with the entire colon and the supply tank being substantially at the same level, and without appreciable pressure, the fluids are taken into the bowel only due to the natural functioning of the muscles of the bowel and colon, and this permits the warm fluids to oscillate freely through the various portions including the descending colon, the transverse colon, and the ascending colon. This is in marked contradiction to the average enema given to the patient so that normally only the sigmoid colon is affected. No attempts is made with this method to actually remove any of the feces from the colon. The whole function is to restore the compacted matter to the plastic condition where normal evacuation can take place after the treatment has terminated, and to stimulate the peristaltic action of the colon. It is for this reason particularly that this form of enema is not habit forming in that it does not act contrawise to the normal functioning of the human anatomy, but, rather merely assists nature in doing its work. It is, of course, desirable to maintain a constant flow of clean liquid into the colon and for this reason it may be necessary to replenish the liquid in the supply vessel several times, so that several quarts of water may be used in the entire operation. it therefore becomes desirable to have a discharge from the return vessel so that the desired supply of clean fluid can be continually supplied.

The two channels formed by tubes 42 and 43 are open at all times during the administration of the enema with all other channels, outlets, and inlets closed.

The double tubes forming nozzle 45 are so constructed and positioned and the tanks 12 and 14 are so constructed and positioned as to insure the flow of a continuous stream of liquid through these two channels without interference, one with the other, except when interrupted by the patients colon reflexes or gas pressure.

Double tubes of prior construction with one tube inside another, as with one channel protruding beyond the other, will not furnish this continuous flow in both directions without interference one with the other and interference of the in-flow with the out-flow has the effect of a boiling spring rather than a continuous stream.

With three pints of liquid in tank 12, with the channels open from tank T2 to the patient and from the patient to tank 1'4, and all other ports closed and with the tube inserted in the rectum of the patient for a distance of four or six inches, the liquid is applied under small pressure from the tank 12 and it starts flowing gently into the rectum.

If the colon should be completely empty and if the colon reflexes are such as not to reject the liquid, the liquid will then follow the colon through the sigmoid through the ascending transverse and decending colon down to the caecum.

However, when the bowel is constipated with usual accompanying gas pressure the colon will reject the liquid at the sigmoid just beyond the rectum and the rejection will cause the liquid to flow through the large chan nel of the double ended tube to tank 14 of the can, thereby releasing some of the pressure from the sigmoid region after which the liquid in tank 14 returns to the colon and the liquid continues to flow into the rectum from supply tank 12.

The pressure and reflexes may again reject the liquid to tank 14 several times in the descending colon before it reaches the splenic flexure causing it to ebb and how between the rectum and tank 14 and this process will continue as the liquid travels through the transverse colon to the hepatic flexure and through the ascending colon to the caecum when the pressure in the colon exhausted and the patient has a' complete peristaltic action with the urge which accompanies it.

The return tank 14 or accumulator is, in effect, con nected in series with the bowels of the patient so that liquid material from the colon may pass with into the accumulator during peristaltic contraction and pass from the accumulator to the colon during peristaltic pansion.

The valve is then turned to allow the water to drain from the rectum, the tubes, and tanks 12 and 14 to the waste can. The tube is removed from the patient and he uses the stool or bed pan for a complete natural evacuation.

During the course of the enema operation it may be necessary to replenish the liquid in tank 12 from one to three times or a maximum use of four quarts of liquid.

To review the method, a simple statement would be it consists of providing a source of liquid having a small head with the bottom of the liquid column at generally the same level as the top portion of the colon of the patient and connecting the source to the colon; providini. an accumulator with. its base at generally the same love as the lower portion of the colon and connected to the colon; and maintaining the source and accumulator in connection until the patient is capable of having a normal evacuation. The equipment shown and described has been found eminently satisfactory in the conducting of the peristaltic enema. The method, however, could be conducted by hand or by substantially differing equip ment. With a considerable loss of efliciency, the method could be performed with two water bags, a nozzle and tubes connecting the water bags and nozzle, the water bags being oriented as herein described. in mechanical equipment of a more complicated nature than herein described, the method could be conducted by providing source of liquid by pump means or the like having tie same pressure as the gravity system herein disclosed. Likewise an accumulator could be provided using pump means or the like, which would respond to the expansion and contraction of the colon in the same manner as my accumulator. These substitute operations by hand and by other equipment are not as desirable as the conducting of the method by the means I have disclosed, but I wish to claim the essential features of the method regardless of the particular means which is employed to conduct the same.

Every facility is provided with this equipment, illus trated and described in this application to achieve these results, therefore it is believed that a truly new and very worthwhile treatment is provided in the teachings of this present application.

The peristaltic enema has proven valuable in the following cases: (1) pro-operative cleansing, (2) post-operative ileus, (3) impactions, (4) megacolon, (5) diverticulosis, (6) colitis, (7) establishment of colostomy function, (8) paraplegias, with loss of bowel function, (9) following hemorrhoidectomies, (l0) removal of barium following X-ray examinations.

it is believed that it will be clearly apparent from the above description and the disclosure in the drawings that the invention comprehends a novel construction of a means for giving peristaltic enemas.

Having thus disclosed the invention, I claim:

1. A method of assisting natural elimination of bowels comprising continuously applying liquid under small pressure to the colon of a reclining patient through a supply.

tube inserted in the rectum of the patient, draining away through a drain tube inserted in said rectum any liquid supplied to said colon in excess of the amount of liquid which said colon can accommodate to thereby prevent transmission of pressure from said supply tube to said colon, said drain tube being in free communication with an accumulator capable of and positioned to hold a substantial quantity of liquid at a level close to the level of the top of the colon and below the top thereof to enable free passage of liquid from said colon to said accumulator and from said accumulator to said colon and maintaining said free communication to permit oscillation of liquid back and forth between said colon and said accumulator.

2. A method as recited in claim 1 in which said drain tube is larger than said supply tube to insure the removal of said excess liquid from said colon at a sufficient rate to prevent transmission of pressure from said supply tube to said colon.

3. A method as recited in claim 1 in which the liquid supplied to said colon is heated.

4. A method as recited in claim 1 in which the free communication between said colon and said accumulator permits peristaltic contraction and expansion of said colon to oscillate liquid back and forth between said colon and said accumulator through said drain tube.

5. A method as recited in claim 1 in which the pressure of liquid in said supply tube is just suflicient toenable said liquid to slowly flow into the colon.

6. A method as recited in claim 5 in which the rate of flow of liquid from said supply tube is between 1.5 and 30 drops per minute when the treatment is initiated.

References Cited in the file of this patent UNITED STATES PATENTS 2,024,967 Dierker Dec. 17, 1935 FOREIGN PATENTS 472,247 Great Britain Sept. 17, 1937 OTHER REFERENCES Industrial & Engineering Chemistry for November 1937, page 1316.

Handbook of Physical Medicine, 1945, American Medical Assn, pages 181 to 191, chapter on Colonic Irrigation by Frank H. Krusen, M. D.

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