Mr lee said:
What size of colon tube should I buy for a beginner? Should it be used for the initial soap enema or for the 2nd or 3rd rinse? How long should the rinse enmas be held? I have used enemas since age 5.
For a beginner, I would recommend about a 40Fr colon tube. When you are more experienced, you can use larger sizes.
the 40 Fr tube is stiff enough to be inserted easily and not fold or kink back on itself, yet flexible enough to get around the bends.
Beginners should especially be given a preliminary enema to void any solid feces and open up the colon prior to inserting a colon tube.
You can use soap initially if you like, but it isn't necessary. Retention is not necessary either. Just get the enema in, massage it around and expel it. You can then take your colon tube and insert it. It will take practice and learning your own internal anatomy before you can insert it very far. And don't think your colon anatomy will match up with what the textbooks describe. Everyone is a little different and some people are VERY different from what text books describe. Don't force the tube.
Depending on the characteristics of the tube (diameter, stiffness) and your ability to know anatomically where it is in your colon and your skill in manipulating it, you could get more than 30 inches, but probably far less than five feet in unless the tube in kinked or folded--and most people don't realize when their tube is kinked or folded inside themselves. Be careful. Read posts on colon tube techniques. Here's what I do:
The method I use to insert the colon tube is to be at least partially cleaned out first and be laying on your back--that is the position colonoscopy is performed in once you get to the transverse colon going on to the ascending colon and cecum. The reason to be on your back, and take a lesson from gastroenterologists here, is because on your back, your colon is on top of all your other abdominal organs. In the knee chest position, all your abdominal organs "fall" onto the colon inside yourself, and the weight of those organs can prevent easy passage of the tube deeper in the colon.
Then when inserting the tube, use lots of lubricant so the anus doesn't get sore. Then allow some water to flow in and close the clamp. Now to insert the tube, I like to use the "jerking off my husband" stroking method as the tube is gradually advanced. What I mean is keep the tube moving in and out in two to four (or whatever is best for you) inch strokes and keep advancing the tube. I never found just twisting the tube to be as effective as the "jerking off" method, which is actually more or less what gastroenterologists do when they insert a colonoscope. They inflate the colon with air, we will use the enema water. If you aren't very overweight, you can feel where the end of the tube is. You can use one hand to insert the tube and your other hand to massage it around the curves.
Periodically, depending on how the tube feels inside you, add more water and close the clamp again and advance the tube more. Keep doing this until all the way in. WARNING: the tube will not go in as far as you think. Unless you have an abnormally tortuous colon or the tube folds over on itself inside you, you won't get in five or six feet of tubing. When the colon is described as 5 to 6 feet long, that is how long it is stretched out on a table, not sitting inside your abdomen.
Consider the colon to be like the slinky toy. You can stretch it out far, but when it is at rest, it isn't that long. To demonstrate my point, look at a chart showing how the colon lies inside the abdomen. Then, take a rubber tube and trace that out on your belly. You'll see there is no way you are getting five feet of tube inside you without its kinking and folding. Three feet is about the maximum you will get. DO NOT force it, especially as you get the end of the tube in to the lower right quadrant where the cecum is.
If you have a heavy, stiff tube (which is really what I like because it is easier to feel inside you and "massage" to where you want it to go) you can puncture your colon, which will cause a life threatening infection or you can damage the ileocecal valve if you try to force it into the ileum.