Tap water and the Malone antegrade continence enema: A safe combination?

Purpose: The Malone antegrade continence enema provides independence and im proved quality of life in patients with fecal incontinence or intractable c onstipation. However, isolated reports of fatal hypernatremia after irrigat ion with normal saline have raised safety concerns about frequent colonic i rrigation in children. Significant electrolyte abnormalities have also been reported with hypertonic phosphate and high colonic tap water enemas. Beca use our patients routinely use tap water for Malone antegrade continence en ema irrigations, we examined the safety profile of this practice Materials and Methods: In the last 3.5 years 71 patients at our institution have used antegrade tap water enemas for managing fecal incontinence or in tractable constipation. Standard serum electrolytes were measured Results: We obtained 101 sets of serum electrolyte measurements in 71 patie nts at a mean of 8.4 months postoperatively (range 1 to 33). A girl who pre sented with severe hyponatremia and hypochloremia had not used the Malone a ntegrade continence enema for several days. The most interesting finding wa s significantly elevated sodium and chloride in 1 case 6 weeks after surger y that was associated with tap water treated with a home softening system. Electrolytes reverted to normal 1 week after using untreated tap water Conclusions: We did not detect significant hyponatremia or hypochloremia in any patient using tap water for Malone antegrade continence enema irrigati on. Although dangerous electrolyte abnormalities are rare, potential morbid ity in those cases warrants periodic evaluation. Due to the elevated sodium content in softened tap water families should be alerted to use untreated tap water for preparing enemas.