Colon cleansing system and technique

According to the present system and technique, with the patient lying on his right side, a soap containing enema solution, preferably with a laxative therein, is introduced into the colon through the anal opening via a suitable tube held in the rectum by an inflated balloon (18), preferably from a bag (11) held above the patient, in a volume, usually sufficient to completely fill the colon all the way to the cecum, usually 1500 cc to 3000 cc in a normal adult. Inflation of the balloon can be accurately controlled by using a calibrated syringe (40), acting through a suitable valve containing conduit (21). The balloon and tube can be further secured in place with a limiting means (19) on the tube outside of the patient's anal opening and/or with specially made device (60) designed to squeeze the patient's buttocks together.

DESCRIPTION 
1. Technical Field 
This invention relates to an improved method and technique for cleansing 
the colon. 
2. Background of the Invention 
There are of course numerous situations which require emptying the colon of 
solid fecal material, liquid or gas. Healthy persons could need such a 
cleansing for any one of a number of reasons including constipation. In 
addition it would be required in a number of medical situations including 
preparation for conducting tests, preparation for surgery and routine 
emptying of the colon for patients such as paralyzed persons or any person 
who cannot perform this function naturally. Preparation for testing would 
include essentially emptying of the colon of solids, liquid or gas prior 
to injecting therein a barium enema for visual observation under an x-ray 
machine. It is preferable to empty the colon for virtually any type of 
surgery in which an anesthetic is used, even if the surgery does not 
involve opening up the thoracic cavity or the abdomen since fecal material 
or gas in the colon exerts a pressure on the diaphragm, hence imposing 
limitations on the ability of the patient to breath, and this in turn can 
lead to collapse of the lungs, pneumonia, vomiting and other problems. 
Disabled persons such as fecally incontinent persons would include those 
disabled by age as well as those paralyzed below the waist, or disabled 
for any reason. 
Present systems for attempting to cleanse the colon include two basic 
procedures; first the use of enemas for the lower colon (from the splenic 
flexure to the anal opening) and second, the use of oral laxatives for 
clearing out the upper colon (from the splenic flexure to the cecum). The 
giving of enemas normally includes multiple enemas of less than 1000 cc, 
normally approximately 500 cc each, which, incidently, are often 
inadequate, while having the patient lay on his or her (referred to 
generically hereinafter as "his") left side. In practice the limit may be 
approximately 500 cc since above this level the enema solution will tend 
to leak out of the anal opening around the tube and onto the bed. A single 
enema of this type is almost never sufficient to cleanse out the entire 
lower colon so that the nurse or aide is normally given directions to 
continue giving additional enemas using the same volume of liquid, i.e. 
about 500 cc, usually until the expelled liquid is "clear". At this time 
the usefulness of the enema procedure is considered terminated and as 
noted above any additional waste material within the patient's upper colon 
is removed by having the patient take laxatives orally and waiting the 
necessary time until such orally taken laxatives pass completely through 
the patient's stomach and small intestine, supposedly or with the purpose 
of cleansing the upper colon including the cecum, the ascending colon, the 
hepatic flexure, and the transverse colon, urging the solid waste material 
into and hopefully out of the already cleansed lower colon. Or the enemas 
may be given after the laxatives. 
Although the above described use of the enema concept, i.e. essentially for 
cleaning only the patient's lower colon, has been used since the 
immemorial, such procedure has certain significant disadvantages. Multiple 
enemas are physically exhausting to the patient. Moreover, they can cause 
dehydration of the patient's body with the attendant loss of water and 
electrolytes, thereby upsetting both the moisture and electrical balance 
of the patient's body. This of course can have severe repercussions on the 
operation of vital organs including the heart. Further multiple enemas 
irritate the anus and internal lining of the colon and this can be very 
dangerous, especially in the case of aged patients or those with a 
diseased colon. In addition to the physical disadvantages, because of the 
odors and mess of enemas there are the psychological disadvantages of 
humiliation and embarrassment. In addition to the physical and 
psychological effects on the patient, there are the very considerable 
monetary disadvantages in this age of sky-rocketing hospital costs. The 
procesure of giving multiple enemas followed or preceded by the giving of 
oral laxatives to complete cleansing of the colon will require in 
virtually all cases at least one additional day in the hospital, with its 
attendant costs. 
Hence, there exists a need for a new and improved system and technique for 
more effectively cleansing the colon. 
SUMMARY OF INVENTION 
It is a purpose of the present invention to provide a new system and 
technique for cleansing the colon. More particularly, its purpose is to 
provide new system and technique so significantly advanced relative to 
previously known procedures that it will permit cleansing of the entire 
colon from the cecum, including the ascending, transverse and descending 
colons, to the anal opening, in a single injection of a cleansing 
solution. 
The present invention is based initially on an analysis of the conventional 
procedure for giving enemas, with and without oral laxatives, the 
shortcomings and defects of these procedures, and the reasons for such 
shortcomings and defects. In accordance with the conventional enema 
procedure, the patient is placed on his left side so that the enema 
solution can flow "downhill" from the anal opening toward the descending 
colon located on the left side. This is entirely consistent with the 
purpose of a conventional enema procedure, which apparently is to cleanse 
only up to and through the descending colon to the splenic flexure. This 
well recognized limitation of the conventional enema procedure probably 
resulted because, inter alia, once a sufficient volume of enema solution 
was introduced to fill the colon up to the splenic flexure, i.e. including 
the rectum, the sigmoid and the descending colon, the patient could hold 
no more liquid, and any additional liquid would simply leak out between 
the walls of the anal opening and the outer surface of the enema tube. In 
any event, as discussed above, the remaining portions of the colon, the 
ascending and transverse colon are not cleansed by the conventional enema 
but are cleaned by the use of laxatives and the like. 
Upon analyzing the conventional enema procedure, with and without the use 
of orally taken laxatives, and upon noting the well recognized limitations 
thereof, I made several discoveries. First, I ascertained the reasons for 
the well accepted limitations on the conventional enema procedures and I 
recognized that whatever reasons historically supported these limitation, 
they were not valid. For reasons set forth above, the patient is placed 
with his left side down. I recognized that liquid then entering the 
rectum, sigmoid and descending colon would then reach a barrier at the 
splenic flexure which could not be crossed. Beyond the splenic flexure, 
the liquid would be travelling uphill. But located in the colon beyond the 
splenic flexure is a body of fecal matter and gas which together form a 
gas lock opposing the flow of cleansing fluid upwardly into and through 
the transverse colon. That is, the solid fecal matter and the gas are 
relatively fixed in place, not easily moved, such that further movement of 
the enema solution would oppose gravity in two ways, the upward movement 
of the liquid and the downward movement of the gas. This problem is 
aggravated by the fact that the liquid entering the descending colon would 
flow under any gas located therein, forcing that gas upward into the 
transverse colon, thus enlarging the body of gas which the liquid would 
have to cross, opposing gravity, to enter the transverse colon. Some have 
suggested altering the conventional enema procedure slightly by placing 
the patient on the right side rather than the left side. This did allow 
some of the enema liquid reaching the splenic flexure to run down the 
transverse colon, possibly entering the ascending colon. However, 
considering the small volume of liquid used in the conventional enema 
procedures, and absent recognization of my subsequent discoveries to be 
discussed below, this alternative did not come close to cleansing the 
entire colon. 
A further discovery involved an analysis of the actual mechanics of the 
interaction between the solid fecal matter or "stool" and the anatomy of 
the colon. A significant problem in cleansing the colon is that the stool 
and the sticky mucus material within the colon become attached to the 
lining of the colon and must be detached. Recognizing that the colon 
stretches, whereas the stool and mucus material do not stretch, I 
recognized that such detachment could be brought about by causing 
distension of the colon throughout its entire length. I accomplished this 
distension by introducing into the patient not the conventional volumes of 
liquid solution but a much greater volume, namely whatever volume is 
necessary to completely distend the colon and fill all inteerstices 
between the stool material and the colon lining, except of course for the 
volume thereof occupied by gas, all the way from the anal opening to the 
cecum. I accomplished this by placing the patient on his right side and 
introducing the necessary quantity of liquid solution into the patient 
while sealing the anal opening by a balloon device to prevent any portion 
of this larger quantity of liquid from leaking out of the anal opening 
around the exterior of the liquid tube. I found that introducing liquid in 
this manner worked quite differently from a conventional left side down 
enema procedure in many respects. Firstly, initially liquid does not 
cleanse the descending colon as well as the left side down procedure since 
gases will now have risen to and collected at the "top" of the descending 
colon ("top" meaning the uppermost part when the patient is on his right 
side) and the liquid solution entering the colon will pass beneath these 
gases. But when the liquid then reaches the splenic flexure it easily runs 
down the transverse colon, easily displacing gases therein which further 
collect in the descending colon. Soon the liquid fills the ascending 
colon. This, to my knowledge, was the first time that anyone had utilized 
an enema solution in such a manner as to completely fill the ascending 
colon. A point is soon reached when the colon is essentially completely 
full of fecal matter, gases and liquid throughout its entire length, 
whereupon it begins to enlarge or "distend", i.e. stretch, and since it is 
full throughout its length, this stretching will take place completely 
from one end to the other end, i.e. from the anal opening to the cecum. 
Such stretching will cause the walls of the colon to detach from the stool 
and mucus attached thereto which of course do not stretch along with the 
colon walls. 
I have further found that best results are achieved by combining this 
distention with an agitating washing action, preferably employing 
mechanical agitation. This is preferably accomplished by rolling the 
patient to the left side down position and possibly back to the right side 
down position, and possibly repeating this procedure several times. This 
causes the liquid in the ascending and transverse colons partially to flow 
back through the transverse colon, displacing the gas in the descending 
colon which now moves back up the transverse colon, the effect of this 
being to permit the liquid to contact the entire inner lining of the 
colon, while agitating same, along the entire inner surface of the colon. 
Summarizing, the colon is distended to some extent, causing an initial 
separation of the colon from the attached mucus and stool material, and in 
this state the entire inner lining of the colon may be washed and 
concurrently mechanically agitated. The stool and mucus, thus separated, 
are more readily capable of being expelled. 
In carrying out the present invention, I would preferably use a liquid 
solution containing a lubricant, preferably castile soap. As is shown, 
castile soap assists in softening and fragmenting the stool. The soap also 
lubricates the fecal matter and the lining, thus facilitating expulsion of 
the fecal matter. What is new, however, is that prior to the present 
invention, the advantages of such a lubricant were realized only with 
respect to the descending colon, whereas utilizing the present invention, 
these advantages are experienced throughout the entire length of the 
colon. Additionally, the ability of this lubricant to stimulate 
contractions of the colon can now be experienced throughout the entire 
length of the colon, in cooperation with the above described distention of 
the entire colon, thus for the first time providing means for 
cooperatively distending and contracting the entire colon, throughout its 
length, with its attendant increased ability to expel all solid and 
gaseous material throughout the entire length of the colon. 
I have further discovered that my new technique is enhanced by including a 
laxative in the liquid solution, and as a result thereof I have discovered 
a new way to administer a laxative. Heretofore, either laxatives and/or 
adequate volumes of water have been taken orally. The delay in gastric 
emptying and the variable small intestinal transit time and absorption 
make the results unpredictable and uncontrollable. A laxative can have no 
effect or can cause violent purging, resulting in severe proctitis, and 
exacerbation of hermorrhoids occurs, and there is a risk of perforating a 
diseased colon. Moreover, what does arrive at the colon arrives only at 
the cecum. If the patient has hard, impacted fecal material in his 
transverse colon and/or descending colon, the laxative action in the 
ascending colon can be disadvantageous and indeed extremely dangerous 
since it can perform its function at that location but be insufficient to 
break the impaction in the downstream areas, resulting only in painful 
cramping, exhaustion and dehydration of the patient, not to mention the 
imbalancing of the patient's electrolytes. Another recently developed 
technique has been to place a laxative in a container having 37 cc of an 
aqueous enema solution and to introduce such solution into only the lowest 
10 cm or so of the colon including essentially the anal canal and the 
rectum. 
A discovery of the present invention is that my technique of completely 
filling and distending the colon with enema solution can further encompass 
the inclusion therein of a laxative material, whereby for the first time 
such laxative material can be uniformly and reliably carried directly to 
the entire mucosa of the colon from the anal opening to the cecum, 
uniformly contacting the mucosa over its entire length as the mucosa 
distends and separates from the fecal material located therein under the 
force of the liquid completely filling the colon, thereby avoiding the 
delays and other disadvantages of orally taken laxatives. Never prior to 
this invention, to my knowledge, has there been any method or procedure 
for carrying a laxative ingredient directly and uniformly to the entire 
length of the colon as is accomplished in the manner expressed above. An 
additional advantage of applying a laxative to the entire colon in this 
manner is that if a pool of fluid remains in any segment of the colon, 
after the first defecation session, the correct concentration of laxative 
is present in the fluid and provides a continuous stimulation to that 
segment of the colon, resulting in complete expulsion of the contents of 
the colon. Contrasting this with the use of a non-laxative liquid 
solution, if a pool then remains at any location in the colon, since it 
does not contain laxative to stimulate expulsion, there is thus incomplete 
expulsion of the contents of the colon. 
Another feature of the present invention is the provision of an enema 
solution containing both a soap for providing lubricating properties and a 
laxative ingredient. One laxative ingredient which I have found to be 
advantageous for this purpose is non-soluble Bisacodyl carried in an 
aqueous suspension. 
The use of soap and Bisacodyl solution is safer than water enemas since it 
is more nearly isotonic (the same osmotic pressure as the tissues and 
hence will not be absorbed) thereby avoiding fluid and electrolyte 
imbalance risks which occur with respect to water enemas. The soap and 
Bisacodyl are much safer than oral laxatives and oral purgatives. 
As described above, the present system and technique employs an inflatable 
balloon at the end of the enema solution tube to hold in the necessary 
volume of liquid solution. Such a balloon has the additional advantage in 
the present invention of permitting the patient to relax, thereby relaxing 
the abdominal wall muscles and allowing greater and more comfortable 
distention of the colon throughout its length and hence stimulating better 
contractions. However, such balloons do present certain problems, 
solutions to which form a part of the present invention. When inflating 
the balloon there is no way to visually observe the size of the balloon 
within the patient. It has been known and documented that in numerous 
cases a balloon has become overinflated and, especially in the case of a 
diseased colon, has ruptured the colon, resulting ultimately in the death 
of the patient. Attempts to limit the amount of air inflated into such a 
balloon have included a small puffer of a known size and capable of a 
single puff. However, such devices are unreliable since they do not take 
into account the residual air present in a balloon prior to inflation and 
they do not measure exactly the volume of air injected. Moreover, at best 
such devices provide only an upper limit, i.e. they do not permit complete 
control over the volume of air in the balloon at all times. 
In accordance with another feature of the present invention, I have 
provided a technique for absolutely controlling the volume of air within 
the balloon at all times. Such arrangement includes attaching the conduit 
which leads to the balloon to one end of a conventional syringe with 
calibrated markings thereon. The conduit should preferably include a 
spring loaded one-way valve normally closing this conduit but opened by 
the end of the calibrated syringe when it is attached to the conduit. If 
the balloon is of the type having residual air therein, then the syringe 
can be applied and the piston therein withdrawn to completely evacuate the 
balloon. This of course has the advantage of providing a minimal size of 
the balloon to facilitate insertion of the tube and balloon within the 
patient. The calibrated syringe would then be separated from the conduit 
(closing the valve) after which the piston therein would be reset back to 
its rearwardmost position, after which the calibrated syringe would be 
reconnected to the conduit, opening the valve, and the piston moved within 
the syringe by an amount positively known by observing the calibrated 
markings, whereby the operator could very closely control and visually 
observe the precise volume of air delivered to the balloon and therefore 
the size of the balloon. Indeed, as has not been possible heretofore, with 
this technique, the operator can increase or decrease the size of a 
balloon already in a patient by precisely determined amounts, to alleviate 
pain or otherwise meet changing conditions, all the time having complete 
knowledge of the volume of air in the balloon and therefore the size of 
the balloon. 
Another characteristic of balloons as have been used heretofore for holding 
tubes within patients is that they are subjected to asymmetrical and 
significant forces tending to tilt the balloon and otherwise pull it up 
into the rectum whereby it will not perform its sealing function. In the 
past, balloons have been stabilized in place by pulling on the enema tube 
or by means of a bar, disc or the like located on the tube outside of the 
patient and exerting a force on the balloon holding it down into sealing 
contact with the rectum adjacent the anal canal. However, these bars, 
discs and the like have tended to be inadequate since they have not in all 
cases perfectly adapted to different size patients. Also, a bar or the 
like extending essentially fore and aft will not prevent tilting of the 
balloon about the fore and aft axis of the patient and hence will not 
completely stabilize the balloon in place. These disadvantages are 
overcome in accordance with the feature of the present invention whereby a 
hard or firm oval or circular disc is atttached to the tube at a location 
farther from the balloon then will be desirable for any given patient but 
arranged such that it can slide in only one direction, namely towards the 
balloon. In combination therewith, the tube can have indicia thereon 
marking positions for different size patients, i.e. one for a very thin 
patient, one for a normal patient and one for a heavy patient. Then, after 
the balloon has been inflated within the patient, and pulled down snugly 
over the lower opening of the rectum, the disc can be slid toward the 
balloon, stopping at the appropriate marker, whereat it will prevent the 
balloon from moving up away from the lower opening of the rectum. 
As another feature of the invention, the disc can be connected with 
suitable straps, one in the rear and two in the front, each off center to 
pass to each side of the genitals, for connection to a waistband or the 
like on the patient, thereby preventing involuntary expulsion of the 
balloon and tube. The disc with the straps attached thereby stablizes the 
balloon against movement in either direction, i.e. in or out. 
A system for carrying out the present method will further include a bag for 
holding the enema solution and a tube leading from the bag and to which 
the balloon would be attached for insertion into a patient. The bag should 
of course be of a large enough size to hold the desired quantity of enema 
solution which can desirably be as high as 3000 cc. Such bags have been 
used heretofore for barium enemas since barium fills the entire colon. 
However, bags intended for cleansing the colon have of course not been of 
this size. The tube leading from the bag to the patient must be of the 
smaller size conventionally used for enema solutions and not of the much 
larger type used heretofore for barium enemas. One reason for this is that 
the thicker barium tubes are required because of the heavy density of the 
barium material. However, enema solutions are essentially aqueous 
solutions which are much less dense than a barium enema. A smaller size 
tube is required to restrict the rate of liquid flow therethrough to an 
appropriate rate. It has been found for example that too rapid a flow of 
liquid into the colon will tend to distend the colon walls very rapidly, 
thus causing pain to the patient. It has been found that pain is sensed 
not by the extent of distention of the colon walls, since full distention 
will merely give a sensation of fullness, not pain, but rather, by the 
rate of distending, or stretching. 
Another feature of my invention is to provide the liquid tube with a smooth 
rounded tip with small openings on the side. With such a tube, insertion 
is safer and more comfortable, avoiding injury to the anus or anterior 
wall of the rectum, or perforation of the rectum wall, as could more 
likely occur with a flat tip. Also it is less likely that the side holes 
would occlude with feces. 
Another advantageous feature of the present invention is the limitation on 
the length of tube from the enema solution bag to the patient. Prior enema 
kits include a tube approximately 60 inches or 150 cm in length, which, if 
fully extended, subjects a patient's rectum to the considerable pressure 
cf 150 cm of water, which is unnecessary in most cases and very dangerous 
in that it can cause rupture of a weak or diseased colon, and in fact has 
done so in some documented cases, resulting in the death of the patient. 
As a safety factor, therefore, I would limit the length of the tube to 
approximately 25-30 inches or 60-75 cm since this provides an adequate 
pressure head, without the attendant dangers of too great a head. 
The balloon used in the present invention should preferably be of a type 
having a large dimension perpendicular to the wall of the tube as compared 
with its dimension parallel to the axis of the tube. Such a balloon, 
however, is necessarily of the type having a residual quantity of air in 
the balloon even in its most relaxed condition. In accordance with the 
present invention, such a more desirable balloon can be utilized, 
notwithstanding the residual air, by combining same with the above 
described calibrated syringe and valve arrangement since the latter can be 
used to completely evacuate even this residual air. 
A patient will always have an urge to completely expel any device held 
within his anal opening, such as the tube and balloon. I have successfully 
prevented such expulsion by various means including straps attached to the 
disc as described above. As another advantageous feature of the present 
colon cleansing system and technique, I have provided a device which 
causes the patient's buttocks to be squeezed together along the mid-plane 
and against the perineum of the patient and held in that position while 
the balloon is in place in the patient. In accordance with the present 
invention, this device is so constructed that it can be applied to the 
patient after the liquid introduction tube and its balloon have been 
inserted into the patient and so as not to interfere therewith. In 
accordance with a preferred arrangement, this device comprises a band 
which wraps around the patient and which includes straps at its ends which 
can be sequentially connected, starting from the bottom and working 
upwardly. 
The specific manner of applying the method of the present invention will 
vary for different situations and different patients. However, briefly 
summarizing the method of the present invention for a typical patient 
wherein it is required to cleanse the entire colon, but wherein the 
patient has no highly specific problem associated with the colon such as a 
diseased or weak colon or the like, such a general procedure would be as 
follows. The bag would first of all be filled with a suitable volume of 
liquid solution, for example approximately 2000 to 3000 cc of a castile 
soap aqueous solution having therein approximately 10 to 20 mg, or more, 
of Bisacodyl in aqueous suspension. This bag would also have associated 
with it a liquid tube leading therefrom with a suitable clamp thereon and 
at the end thereof a balloon adapted to be inflated at a later time within 
the patient and an oval disc adapted to be moved up against the patient. 
The patient would then be placed on his right side. A syringe would be 
connected to the conduit leading to the balloon to withdraw residual air, 
thereby completely collapsing the balloon. Standing in front of the 
patient, the nurse would then insert the end of the tube and the balloon 
into the patient's anal opening and the calibrated syringe would be moved 
a specific amount, as observed on the calibrated markings on the syringe 
to inflate the balloon to a precise predetermined size. The disc located 
on the tube is slid therealong to secure the tube and balloon in place in 
the patient. If the patient is of the type which might expel the balloon, 
straps or the device for squeezing the buttocks together and against the 
perineum can then be applied if desired, to keep the tube and balloon in 
place in the patient. The clamp is then opened, permitting the liquid 
solution to flow through the tube and into the patient. The liquid at this 
time has a sufficient head to flow "uphill" (with the patient on its right 
side) along the rectum and sigmoid and along the descending colon. The 
liquid then flows downwardly along the transverse colon, displacing 
upwardly to the descending colon any gases located therein. The liquid 
then continues its movement along the ascending colon to the cecum. After 
liquid has reached the cecum, thereby filling the colon (i.e. filling the 
interstices in the colon between the pieces of stool, and not taken up by 
gas in the colon), the next phase is entered, whereby this liquid tends to 
distend the lining of the colon which has the capability of stretching, 
said action thereby separating the lining from the fecal material located 
therein by shearing forces since the fecal material does not stretch. If 
the rate of flow of the liquid into and through the colon is kept at a 
relatively slow rate, the distention of the colon will not be too fast, 
and consequenty the patient will feel only a sensation of fullness, but 
not pain. This separation of the colon from the fecal material therein 
tends to expose the surface of the mucosa to the liquid which has been 
introduced. Hence the laxative ingredient included therein can now reach 
the entire lining of the colon in a uniform manner not possible with any 
other procedure of which I am aware. The liquid is held in the patient for 
a short period of time. Although the emphasis of my method is "right side 
down" during insertion, during the holding period the patient will 
preferably be rolled several times to a left side down position to detach 
stool and mucus and to permit the liquid to move into those portions of 
the descending colon where gases may still be located to permit the liquid 
solution, including the laxative ingredient therein, to contact the mucosa 
in those portions. The patient is then taken to a suitable receptacle, the 
balloon is deflated, any straps or devices squeezing the buttocks together 
are released, the tube is removed and the patient at this time can expel 
the entire contents of the colon including all of the liquid and all of 
the solid material and gases therein. 
As noted in the preceding paragraph I have found it advantageous for the 
nurse to stand in front of the patient as contrasted to the conventional 
technique of standing behind the patient. In front the nurse can observe 
the patient's reactions more accurately and communicate with the patient 
more effectively than if standing behind the patient. Also the nurse, 
standing in front, need not lose contact with the patient when assisting 
the patient off of the bed and to the potty chair or toilet. Otherwise, if 
standing behind the patient, the nurse would have to leave the patient's 
side and move around the foot of the bed to the other side to assist the 
patient. Finally it is much safer for the nurse to stand in front of the 
patient as it eliminates the possibility of the nurse being soiled by 
feces as could occur if the nurse were standing behind the patient and the 
patient involuntarily expelled the balloon. 
Tests to date indicate that the single procedure is effective to remove 
more than 95% of the fecal material and gas in over 95% of the cases 
tested. If removal of more nearly 100% of the fecal material is desired 
for any reason, the entire procedure can be quickly and easily repeated as 
often as necessary. The present concept of cleansing the entire colon in a 
single procedure has the advantages, as compared to the conventional 
enema, of avoiding the risks, humiliation, embarrassment and the indignity 
of multiple enemas and the humiliation, embarrassment and indignity of the 
unpredictable results of laxatives given orally. Moreover, precisely 
because the entire colon is cleansed, leaving no feces in the ascending or 
transverse colons, fecal impaction is prevented, as are the dangers of 
repeated digital fragmentation of impacted feces, and its associated 
humiliation and embarassment. Also eliminated is the humiliation, 
embarrassment and indignity of accidental bed soiling (a) due to leakage 
of the enema liquid during the conventional enema procedure, this being 
prevented by the use of a balloon, and (b) due to subsequent involuntary 
expulsion of fecal matter, especially in the case of fecally incontinent 
patients, this being prevented by the fact that the entire colon was 
cleansed in the first place. Moreover, the risk of infection from soiling 
of the patient, the bed linen and the nurse with feces is minimized. 
Additionally there are the significant cost savings since a colon can be 
completely cleansed in a single hour rather than by an .about.hour 
overnight program. Less personnel time and less equipment are required. 
The costs of changing and laundering soiled bed linen and bathing the 
patient are virtually eliminated. 
Hence, it is an object of the present invention to provide a new and 
improved system and technique for cleansing the colon. 
It is another object of the present invention to provide a new system and 
technique for cleansing the colon wherein the entire colon can be cleansed 
in a single operation. 
It is another object of this invention to provide a new material as a 
vehicle and a new system for carrying a laxative ingredient uniformly to 
the entire lining of the colon. 
It is another object of this invention to provide a new system and method 
for safely inflating a balloon adapted to hold a tube in the anal opening 
of a patient. 
It is another object of the present invention to provide a new device for 
positively holding a tube and its inflatable balloon within a patient by 
moving the patient's buttocks together and against the patient's perineum. 
It is still another object of this invention to provide a new and novel 
system for carrying out the above objects, which system is new, and which 
includes a number of separate integers which work with each other, many of 
which integers are themselves new. 
These and other objects and advantages of the present invention will become 
apparent from the detailed description to follow.

DETAILED DESCRIPTION 
There follows a detailed description of the preferred method and system of 
the present invention. Whenever, in this discussion, reference is made to 
the drawings, like elements are represented by like numerals throughout 
the several views. 
Referring now to FIGS. 1 through 5, there is shown and described those 
elements which comprise the system or apparatus for carrying out my new 
colon cleansing technique. 
The system 10 would include a solution bag 11 for storage of cleansing 
solution. The bag would be of a conventional character and in fact can be 
of the type now sold by Bard, except that it would have a larger volume, 
for example a volume of over 2000 cc, and preferably 2500 or 3000 cc. Such 
a bag would be provided with graduations 12 and an opening 13 at the upper 
end, such as an unscrewable watertight cap for introduding liquid into the 
bag. A suitable aperture 14 may be provided at the very top for hanging 
the bag on a hook in use. 
At its lower end, the bag 11 would include a connection 15 to a tube 16 for 
delivering the liquid solution to the patient. The tube would include a 
suitable clamp 25 thereon. It is important that the tube 16 be of a type 
and size appropriate for delivering an aqueous liquid solution to the 
patient, as contrasted with other types of tubes which are larger and 
stiffer for delivering thicker liquids such as barium enemas. One suitable 
tube for this purpose has an inside diameter of 3/16 of an inch and an 
outside diameter of 1/4 inch, leaving a thickness of 1/16 of an inch. The 
thickness may preferably vary in the range between 1/32 of an inch and 
1/16 of an inch. There are several reasons for preferring, if not 
requiring a tube of a suitable type. Firstly, if it is preferred to use a 
tube which extends more than a minimal distance beyond the balloon (such 
as balloon 18 to be described in greater detail below), then that end of 
the tube will engage the inside wall of the rectum as it is inserted 
therein, and unless it is soft enough and thin enough to bend up within 
the rectum, the tube may cause injury to the wall of the rectum and pain 
or injury to the prostate (in a male) or cervix (in a female) located 
immediately therebeyond. Secondly, a small inside diameter tube is 
required for the proper rate of liquid flow. Pain is caused in the patient 
not by the insertion of a large quantity of liquid (this will only provide 
a sensation of fullness) but by a rapid introduction of such liquid which 
results in excessively rapid distention and stretching of the lining and 
wall of the colon. This is especially important in cases where there is an 
obstruction or a diseased colon which might be friable and tear easily. A 
torn colon can result in infection and death. 
Another advantageous characteristic of the tube 16 is its length which 
heretofore has been provided in most enema kits approximately 60 inches 
long, which length is unnecessary and dangerous in that it makes possible 
the placing of the bag a full 60 inches above the patient, thus providing 
a pressure or head equal to 60 inches of water felt by the patient. This 
is excessive, unnecessary, and can cause rupture of the colon, especially 
in the case of an aged or diseased colon. Hence, a feature of the present 
invention is that the tube 16 is limited to approximately 30 inches or 
60-75 cm, thereby acting as a safety measure preventing the bag from being 
placed at too great a height above the patient. 
The end of the tube remote from the bag is shown in FIG. 1 and associated 
elements thereof are shown in greater detail in FIGS. 2 and 3. The remote 
end 17 is preferably a solid rounded end with a pair of openings 17a and 
17b on the side thereof. The smooth rounded tip is safer to insert past 
the delicate anal tissues and is less likely to damage the anterior 
(front) wall of the rectum. Also, the side holes on the tip are less 
likely to occlude with fecal matter. Referring to these figures, near the 
remote end 17 of the tube 16, there is provided an inflatable balloon 18, 
which balloon is deflated completely during insertion, and then inflated 
after being inserted, said balloon located at the lower end of the rectum, 
thereby holding the liquid in the colon. In order to prevent injury to the 
patient, it is important that the amount of air delivered to the balloon 
18 be carefully controlled. One way to acomplish this is to make the 
balloon out of a flexible non-stretchable material, thereby limiting its 
maximum size. This arrangement has the advantage of absolutely limiting 
the maximum size of the balloon, thereby positively preventing 
overinflation. However, such embodiment does not permit inflation of the 
balloon by varying amounts. Accordingly, to provide such absolute control 
of balloon 18 by different amounts, the conduit 21 leading to the balloon 
18 is connected via a valve 22 to a piston and cylinder type syringe 23, 
to be described in greater detail below. 
Referring to FIGS. 2 and 3, there is also shown a limiting means 19 in the 
form of a disc. This disc 19 may be necessary for at least two reasons. 
Firstly, in practice the end 17 of the tube and the balloon 18 may be 
subjected to varying asymmetrical forces tending to tilt the balloon, 
pulling it out of sealing contact with the walls of the rectum at the 
lower end thereof. Hence, to stabilize the balloon and maintain it in 
place to assure a good seal preventing fluids from passing between the 
exterior of the balloon and the walls of the rectum and anal canal, the 
disc 19 would be moved up against the exterior of the patient's anal 
opening and pressed thereagainst. Contrary to some previous limiting means 
used heretofore, I have found that stabilization of the balloon 18 is best 
achieved by the use of a generally circular, preferably oval, disc shape 
limiting means. A feature of the present invention is a construction 
whereby the disc 19 can be moved in one direction only and positively 
prevented against movement in the other direction, so that it can for 
example be slid to different positions, indicated as A, B and C at the 
graduations 20 in FIG. 2, to represent a heavy person, a normal person, 
and a thin person, respectively, the disc being so constructed that after 
moved to such positions, it cannot be moved back. While many different 
constructions can achieve this purpose, such as ridges with one sloped 
side and one narrow side, in the drawings I have shown attached to the 
disc 19 a sleeve 24 of for example a flexible plastic material extending 
for a distance relatively large as compared with the thickness of disc 19, 
such that movement of disc 19 to the right would be possible, but movement 
of the disc to the left would exert on the sleeve 24 frictional forces too 
great to be overcome with reasonable or usual forces. 
To positively prevent expulsion of the tube and balloon 18, loops 30, 30a 
and 30b could be provided on the disc 19, each having attached thereto 
suitable straps 31, 31a and 31b, respectively, to be attached to a 
suitable waistband on the patient. 
Referring to FIGS. 2 and 5, the balloon 18 is preferably of such a shape 
that when inflated it extends outwardly for a relatively large distance as 
compared for example to its dimension parallel to the axis of tube 16. 
There are two reasons for this. Firstly, such a shape minimizes the 
distance which the balloon, in its collapsed condition, must pass up into 
the anal canal before it is properly inserted. Secondly, such a balloon 
would provide a smaller volume, and hence a smaller surface area against 
which can act those muscles of the patient tending to expel the device. 
One disadvantage of such a balloon, however, is that in its natural, 
completely relaxed state it would tend to include residual air therein 
which should preferably be removed during insertion of the tube and 
balloon. However, complete exacuation of even this type of balloon is 
possible with the use of a piston and cylinder syringe control device and 
valve to be described below. 
Referring to FIG. 4, the end of the conduit 21 includes a one-way valve 22 
having a valve element 51 spring biased by a spring 54 into the closed 
condition wherein a surface 52 thereof firmly seats against a valve seat 
53. The spring 54 rests at its other end against an open cage 55. A 
calibrated piston and cylinder syringe is provided for cooperating 
therewith. This device includes a cylinder 40 having a piston rod 41 
extending therethrough with a piston 42 at the end thereof, which piston 
scalingly engages the inside wall of cylinder 40. On its side, the 
cylinder includes calibrated markings 49 for positively indicating the 
precise volume of air which has been introduced into and/or removed from 
the balloon 18 via conduit 21. Cylinder 40 includes a finger grip portion 
48 and the piston rod 41 terminates at its outer end at a thumb push 47. 
In a manner which is known with respect to syringes, the operator would 
engage the portion 47 with the thumb and hold the finger grip portions 48 
with the first two fingers of that hand. At its other end, the cylinder 40 
includes a sealing flange 43 and the end would be closd by a structure 
including a raised central boss 44 with a fluid opening 45 passing 
therethrough. In practice, the end of the syringe would be engaged with 
the end of the conduit 21, whereby end 56 of the conduit would pass into 
the annular recess 46 between the boss 44 and the flange 43, thereby 
providing an air tight seal while the boss 44 engaged element 51, pushing 
it to the right, and unseating the valve. With this arrangement, the 
conduit 21 would then be closed at all times except when engaged by the 
syringe 23, at which time the valve would be opened for air flow in either 
direction. 
The provision of a calibrated piston and cylinder syringe, and the use 
thereof for inflating a balloon in the present invention provides 
significant advantages. It permits the operator to accurately control the 
precise size of the balloon, which control is not otherwise possible since 
the balloon is not visible during the filling procedure. Heretofore, 
various devices such as limited capacity "puffers" have been used which 
provide a maximum quantity of air to the balloon to prevent overinflation. 
However, even these have not provided a way to precisely and visually 
measure the volume of air thus delivered to the balloon, and such previous 
means did not provide a way to precisely and exactly change the volume of 
the balloon after it has once been inflated with complete knowledge as to 
the amount of air added or removed. Hence, the operator is then able to 
precisely control the size of the balloon for different size patients and 
for different conditions within a given patient as well as positively 
protect against overinflation which could rupture the colon and kill the 
patient. 
It is important that the valve mechanism positively be closed to prevent 
leakage from the balloon and to be positively opened for desired air flow 
through the conduit 21 in either direction. Only in this manner can the 
precise volume of air introduced be known as otherwise (for example if the 
valve were a one-way check valve opened by air pressure introduced into 
the balloon) the air would compress before opening the valve so that the 
operator would not have an accurate visual indication of the volume of air 
introduced. 
Another feature of the present invention is the liquid solution to be used. 
Preferably the solution will be a known concentration soapy aqueous 
solution including approximately 20 cc of castile soap, or known 
additional volume of soap as required, in a volume of 1500 cc to 2000 cc 
of water with the addition thereto of a nonsoluble laxative in aqueous 
suspension. In practice, I have found it desirable to include such a 
laxative in a concentration suitable for a parficular patient's problems. 
In most cases I have found it suitable to add the laxative in an amount 
between 0.006 and 0.015 mg per cc of solution, although for different 
situations even this range could vary. I believe the provision of a 
castile soap solution with a laxative ingredient in suspension is new. 
Further, I believe the present invention includes a new vehicle for 
introducing such a laxative ingredient to the patient, namely by applying 
it in a procedure which completely fills and distends the colon, thereby 
carrying the laxative ingredient in a single step uniformly to the entire 
surface of the colon from the anal opening all the way to the cecum. 
Another feature of the present invention is a means for squeezing the 
patient's buttocks together and against the perineum to prevent 
involuntary premature explusion of the balloon 18 and the liquid contained 
in the colon. Referring to FIGS. 6 through 8, and first to FIG. 6, there 
is shown a band 60 having a right side 62 and a left side 63. FIG. 6 views 
the outer side of the device, i.e., the side which would face away from 
the patient, when the device is in use. The left and right sides join 
along a front portion which is narrower than the remainder of the device 
so as not to inhibit the patient's bending his legs at the hips. When 
applied to the patient (in the manner as described below), the left and 
right sides must be rigidly attached together, as shown. However, for 
providing a quick release after the patient is finished with it, the left 
and right sides may be connected together at the front by a suitable quick 
release connection. In the preferred embodiment, this quick release means 
would comprise an overlapping Velcro connection, i.e., an extension 62a of 
the right side could comprise a felt pad which would be engaged by a 
Velcro hook pad on an extension 63a of left side 62. For a quick release, 
one would simply grab the end 61 of 63a and strip 63a from 62a. It will be 
apparent that other quick release means such as buckles, snaps or the like 
can be provided. The device includes a plurality of straps 67, 69 and 71 
on the right side each having at its outer end a felt pad 68, 70 and 72, 
respectively (these pads are on the opposite side and hence not visible in 
FIG. 6). Between the planes of these straps there are provided Velcro hook 
pads 64, 65 and 66. On the left side there are provided further series of 
straps 75, 77 and 79, each with a similar felt pad 76, 78 and 80, 
respectively. While the pad 78 is not visible, the pads 76 and 80 are 
visible since the ends of straps 75 and 79 have been turned back. Also 
included are Velcro hook pads 72, 73 and 74 located between the planes of 
the straps 75, 77 and 79. It will be observed that the three straps on 
each side are spaced vertically from the planes of the three straps on the 
other side, and each of the six straps in fact lines up horizontally with 
a Velcro hook type pad on the opposite side. 
In operation of the device 60, the tube 16 with balloon 18 would first be 
inserted. Referring to FIG. 7, the attendant would then apply device 60 by 
wrapping the device 60 around the patient, at first with none of the 
straps attached but with 62a and 63a secured together. To squeeze the 
buttocks together it is preferable to start from the bottom and work up. 
The operator would grap the two straps 71 and 79 and pull them tightly to 
the left and right, respectively, attaching the strap 71 by connecting the 
felt pad 72 to the Velcro hook pad 74. The operator would then grab the 
two straps 79 and 69 and pull them to the right and left, respectively, 
attaching the pad 80 to the Velcro hook pad 66. This process would be 
repeated until all of the straps were attached in this manner. While 
Velcro attachments are preferable, it will be apparent that other types of 
attaching means such as belt buckles and the like will also be operable in 
carrying out the present invention. With the tube 16, and balloon 18 and 
device 60 in place, the attendant would inflate the balloon and pull it 
down snugly against the lower end of the rectum adjacent the anal canal. 
The friction between the tube 16 and the straps which it engages (69 and 
79 in FIGS. 7 and 8) will hold the balloon down into sealing engagement 
with the lower end of the rectum, thus performing the function ascribed 
above to disc 19, stabilizing the balloon in a fluid sealing position, in 
addition to its function of preventing involuntary expulsion of the 
balloon and tube. 
The method of the present invention and the operation of the above 
described system for carrying out the purposes of the invention is as 
follows. The method will be better understood with reference to FIGS. 9A 
through 9E. FIG. 9A illustrates the entire colon with the parts labeled, 
such labels followed with such representative letters which are those 
letters used in subsequent FIGS. 9B through 9E. FIG. 9A illustrates a 
colon filled with solid waste material, i.e., unloosened fecal matter and 
gas. The figure is intended to illustrate that the gas pockets can 
actually be located randomly at different locations although obviously as 
the patient moves to different positions, the gas will tend to rise to a 
high point. 
FIG. 9B illustrates the application of a conventional left side down enema 
to the colon filled as shown in FIG. 9A, and in particular it illustrates 
the colon after all of the liquid solution, usually between 500 cc and 
1000 cc has been introduced into the patient's colon. In FIG. 9A the 
unloosened fecal matter was particularly difficult to move because it 
would tend to stick to the inside lining of the colon. In FIG. 9B the 
liquid moves along the side of the rectum, down the sigmoid and along the 
bottom of the descending colon (i.e., "bottom" as shown in FIG. 9B). The 
only portions of the colon lining which have been "washed", i.e. which 
have been subjected to the action of liquid in motion are the "lower" 
portions of the rectum and descending colon as shown in FIG. 9B with the 
wide gray border. The upper surfaces of the rectum and descending colon, 
as shown in FIG. 9B, may or may not have been washed, depending on the 
quantity of gas existing therein and possibly blocking contact of the 
liquid with those wall portions. However, the liquid cannot rise upwardly 
in the transverse colon. Firstly, it would have to oppose gravity just to 
travel in that direction. Secondly, gases which may have been located in 
the descending colon will now form a rather substantial gas lock. The body 
of solid fecal matter and the large gas lock tend to form a "wall" 
identified generally by the letter w in the figure. The liquid introduced 
in this manner may cause some distention in the wall of the rectum, 
sigmoid and descending colon, but not beyond those parts. In additional 
liquid is introduced, it will tend to leak outwardly around the tube and 
through the anal opening as shown by the arrow in the figure. Since under 
no circumstances can this liquid pass the area of the splenic flexture and 
rise in the transverse colon, the transverse and ascending colons will 
remain filled no matter how many enemas are given (and it is a common 
practice to give multiple enemas). Indeed, FIG. 9B illustrates the fallacy 
in believing that the colon is clean when, after a number of enemas, the 
solution runs out "clear". This would most likely indicate that only the 
rectum, sigmoid and descending colon have been cleansed, and that the 
liquid in the area of the splenic flexture, being blocked by the gas body 
in this area, simply did not touch the solid fecal matter in the 
transverse colon and ascending colon. Hence, the liquid would of course 
run out "clear". 
When the left side down conventional procedure has been completed, the 
entire mass in the ascending and transverse colon must then be cleaned by 
oral laxatives with all of their attendant disadvantages as discussed 
above or remain in the colon to harden or "impact" or soil the bed if the 
patient is fecally incontinent. 
FIGS. 9C through 9E illustrate the functioning of the colon in the 
operation of the present invention. 
With clamp 25 closing tube 16, an appropriate volume of liquid solution 
would be introduced through opening 13 into bag 11. The balloon 18 would 
then be completely evacuated. Referring to FIGS. 5A through 5C. FIG. 5A 
illustrates the balloon in its completely inflated condition and FIG. 5B 
illustrates the balloon in its completely relaxed condition. However, the 
residual air still located therein should preferably be removed prior to 
insertion of the tube. For this purpose the conduit 21 can be connected to 
the syringe 23 and the piston 42 withdrawn thereby evacuating the balloon 
18 as shown in FIG. 5C. The syringe would then be disconnected from the 
valve 22, permitting the valve to close, and the piston 42 would then be 
pulled back enough to provide precisely the desired amount of air to 
inflate balloon 18 which might be for example 60 or 120 cc. With the 
attendant preferably standing in front of the patient, the tube is then 
inserted into the patient. If the device 60 is to be used, it is applied 
at this time in the manner described above. With the syringe 23 attached 
again to the conduit 21 the piston 42 is moved forwardly, introducing 
precisely the correct quantity of air, e.g. 60 cc to 120 cc, the exact 
amount being visually observed by noting the calibrated markings 49 on 
syring 40. If device 60 has not yet been applied, the disc 19 may now be 
slid along tube 17 to the correct position to stabilize and secure the 
seal of balloon 18. To prevent expulsion of balloon 18, the straps 31, 31a 
and 31b could now be connected to a waistband or the like on the patient. 
Alternatively to said straps, the device 60 could now be applied, this 
time serving only the function of preventing involuntary expulsion of the 
balloon. 
With the patient on his right side, the clamp 25 is then opened, permitting 
the liquid solution to flow through the tube 16. Referring to FIG. 9C, 
this quantity of liquid, prevented from escaping by balloon 18, flows 
along the rectum, up the sigmoid and along the "bottom" of the descending 
colon (gas having risen to the top thereof) and then down the transverse 
colon, displacing upwardly any gases located therein, around the hepatic 
flexure, and along the ascending colon to the cecum. As the liquid 
solution is initially being introduced, some distention may occur in the 
vicinity of the rectum, the sigmoid, descending, transverse and ascending 
colon. However, operable levels of distention throughout the colon do not 
occur until after a sufficient quantity of liquid has been introduced to 
the colon to fill the colon throughout its length, but for the space taken 
up by the solid fecal matter and gases already located therein. As shown 
in FIG. 9C, at this time those walls bounded by the wide gray margin, 
namely the lowermost part of the rectum, the sigmoid, the "bottom" of the 
descending colon and the ascending colon have most likely been contacted 
by a sufficient amount of liquid solution in motion to have been agitated 
or "washed". As distention of the walls occurs along with this washing 
action, the lubricating action of the castile soap in the liquid will 
cause the stool and mucus attached to the walls of the colon to soften, to 
fragment and to detach from the lining of the colon, and to become 
lubricated. Further, as the fecal matter or "stool" is detached, the 
laxative within the liquid solution is permitted to contact the lining of 
the colon, causing it to contract. At this time it cannot be certain 
whether the entire lining of the colon has been contacted by the liquid 
solution. For example as shown in FIG. 9C, gases collected at the top of 
the rectum and descending colon may have prevented the liquid solution 
from removing fecal matter and mucus from the lining of these places. 
Similarly, as the liquid ran down the transverse colon, it cannot be 
certain whether the walls of the transverse colon were "washed" 
sufficiently to remove stool and mucus therefrom. To assure that the 
liquid "washes" and that the laxative contacts the entire surface area of 
the colon lining, the patient may then be rolled over to his left side, 
creating the situation shown in FIG. 9D. Now the liquid flows to the 
"down" side of all segments of the colon assuring contact with and washing 
of all areas of the lining bordered by the speckled margin in FIG. 9D. The 
swashing action of the liquuid back and forth through the transverse colon 
as the patient is moved from his right side to his left side (and this 
action of right side to left side may be repeated as many times as 
necessary) will surely have caused the necessary washing of the entire 
surface area of the lining of the colon with the resultant softening, 
fragmenting and lubricating of the attached fecal matter and the 
consequent contacting of the entire lining with the laxative containing 
liquid. 
Finally, the patient will be rolled back to the right side, as shown in 
FIG. 9E, all lining surfaces having been contacted by the liquid so that 
all of the fecal matter and mucus material within the colon will have been 
loosened, softened, fragmented and lubricated, and the entire lining of 
the colon, having been contacted with the laxative, will be capable of 
undergoing contraction to expel all solid liquid and gaseous materials 
contained therein. 
The volume of liquid solution will vary depending on several factors, 
including the size of the patient, the amount of solid and gaseous 
materials already present in the colon prior to introduction of the liquid 
solution, and the condition of the patient's colon. For example, while I 
have indicated previously that the 1500 cc to 3000 cc of liquid solution 
would normally be used, even less than 1500 cc may be necessary to fill 
the colon in the case of a child, infant, or person who has had a portion 
of his colon removed. 
The advantage of bringing the laxative to the entire lining throughout the 
entire colon is accomplished expecially well in the course of the present 
invention. The laxative, to carry out is stimulating function, must 
contact the lining itself, and not merely the mucus layer on the lining. 
The colon cleansing technique of the present invention, with its ability 
to clean off the entire colon lining, assures that the mucus layer is 
detached along with the stool to thereby fully expose the lining itself to 
the laxative. 
It was suggested above that the patient be rolled to the left side to 
provide further agitation to enhance "washing" of the walls of the colon 
and thereby better effect detachment of the stool and mucus from the 
lining. However, such agitation can be carried out in other ways. For 
example direct in and out motion of the anterior abdominal wall can be 
provided by direct hand pressure or by a vibrator placed against the 
abdominal wall. Also liquid can be moved in and out of the colon by having 
the fluid located in the colon connected through the tube to a fluid 
column which can then be raised or lowered, resulting in the fluid being 
introduced into and temporarily removed from the colon. Alternatively, the 
balloon 18 can be slightly inflated and deflated at proper frequency to 
cause a wave or churning action of the liquid in the colon. Or 
alternatively ultra sound procedures can be utilized to effect agitation 
by vibration, for example by having the liquid run through the tube and to 
a fluid column which can be acted upon. 
Whatever mechanical agitation is used, when it is completed, the patient is 
taken to a proper receptacle, the device 60, if used, is released by 
uncoupling extension 63a from 62a, the balloon 18 is fully deflated and 
removed with the tube 16, and at this time the patient can expel the 
entire contents of the colon. 
Although the invention has been described in considerable detail with 
respect to a preferred embodiment thereof and a preferred operation 
thereof, it will be apparent that the invention is capable of numerous 
modifications and variations which will be apparent to those skilled in 
the art.