Fecal impaction and severe chronic constipation can have significant consequences on patients’ mortality, morbidity, psychosocial well-being, and health care costs. It is especially prevalent among the elderly and individuals with neurogenic bowel disorders. The condition can lead to life-threatening complications like bowel obstruction, intestinal perforation, fecal incontinence, and urinary retention.

Traditional treatments for fecal impaction and severe constipation include lifestyle changes, fiber supplementation, laxatives, suppositories, enemas, and digital stimulation. However, when these treatments fail or are intolerable, the pulsed irrigation evacuation (PIE) device offers an innovative solution. It is designed to provide relief for patients with neurogenic bowel, recurrent fecal impactions, and severe constipation when other methods are ineffective or not tolerated.

This PIE device pulses warm water into the colon under limited pressure and controlled volumes to hydrate stool and stimulate a peristaltic response from the colon, resulting in a bowel evacuation. In use since 1986, the PIE device is indicated for a wide range of medical conditions, including, but not limited to, spinal cord injuries, Parkinson’s disease, multiple sclerosis, and spina bifida.

Clinical studies have shown that the pulsed irrigation evacuation (PIE) device is a safe and effective tool for managing chronic bowel conditions, treating fecal impaction, and preparing for colonoscopy procedures. This article highlights the findings of various clinical studies that demonstrate the safety and efficacy of the PIE device.

Treatment of fecal impaction. Kokoszka et al. (1994) assessed whether PIE could prevent disimpaction surgery in patients with massive fecal impaction. The PIE procedure successfully broke up the fecal impaction, and no patient required hospitalization for impaction.

Management of neurogenic bowel. Puet et al. (1997) found that PIE is a safe and effective way to manage neuropathic bowel in patients with spinal cord injury. The study successfully conducted 398 PIE procedures in both in-patient and out-patient settings.

A study by Gramlich and Puet (1998) demonstrated the long-term safety of PIE in patients with spinal cord injuries. After an average of 6.7 years using PIE, pathology results showed no evidence of epithelial damage or abnormal inflammatory infiltrate. There were also no cases of bowel injuries caused by the PIE device.

PIE for rectal impaction in children. Gilger et al. (1994) assessed the safety, efficacy, and comfort of PIE in children with chronic constipation, encopresis, and rectal impaction. The study found that PIE is safe, effective, and comfortable for children, with 78 percent of procedures successfully removing at least 50 percent of the feces from the colon.

Colonoscopy prep. Apart from treating fecal impaction and managing neurogenic bowel, the PIE device has been studied as an effective alternative for colonoscopy preparation. It can help increase the colon prep as well as physician satisfaction due to a clean prep.

Ayub et al. (2017) compared PIE, polyethylene glycol (PEG), and sodium phosphate colon preparations. Patients in the PIE group experienced the highest rates of good or excellent colonoscopy prep (91 percent) and the lowest rates of pain, cramps, nausea, or vomiting. In another study, Ayub et al. (2000) evaluated PIE for colon cleansing prior to colonoscopy. Colon cleansing was graded as acceptable or better in all 20 patients, and the authors concluded that PIE could be used as primary colon preparation or for same-day cleansing for those with poor traditional preparation.

Lyons et al. (2014) compared PIE with polyethylene glycol-electrolyte lavage solution (PGL) for bowel preparation in veterans with spinal cord injuries. The study found that PIE resulted in lower Ottawa scores and a higher percentage of acceptable outcomes, demonstrating its safety and effectiveness for bowel preparation in patients with spinal cord injury.

The PIE device has been proven as a safe and effective solution for managing chronic bowel conditions, treating fecal impaction, and preparing for colonoscopy procedures. Its versatility and positive results make it a valuable tool for health care providers and patients alike, and it can be a valuable tool in managing fecal impaction and improving patient outcomes while reducing health care costs.

Mahesh Moolani is an internal medicine physician and author of Tough Decisions In Care Of Elderly Loved Ones (A guide for caregivers).