Percutaneous Endoscopic Colostomy - a personal perspective

A Percutaneous Endoscopic Colostomy (PEC) is carried out to help relieve severe bowel problems. An incision is made into the colon and a tube is inserted, through which patients can irrigate their colon once or twice a day. It offers an alternative to a colostomy, where faeces are collected in a bag. With a PEC, patients can empty their bowels into the toilet. Then the tube is taped out of the way. It is still a relatively new and innovative procedure.

Two readers tell us about their experience of the operation.

"I have battled with bowel incontinence for some 28 years after suffering a third degree tear at the birth of my first child which my GP had repaired on the assumption that I would be fine. It took 5 years of feeling alone, frightened, worried and ashamed before I managed to tell my GP what was really causing the anxiety I was being treated for.

I was referred to St. Marks Hospital, where several tests were done and I had a Post Anal Repair. Unfortunately the repair made the incontinence worse, but in those days there was nothing more that could be done. I had suffered with constipation from childhood and these were the times when the passive leakage was worst, so it became a regular thing to juggle food, fibre and laxatives in order to keep the constipation away and keep the incontinence to a minimum.

At the age of 50 the constipation became chronic and the incontinence was happening 10 or more times a day and was controlled by unpleasant manual evacuation.

The local hospital consultant referred me back to hospital where I had similar tests carried out again and was given bio-feedback treatment. Sadly this didn't work for me, and other medicinal remedies were tried but the only thing that worked was rectal enemas. These were time consuming, messy and extremely painful. The alternative was a full colostomy which is something I could not personally accept.

My Consultant Nurse Specialist and Colorectal Surgeon proposed a new technique called Percutaneous Endoscopic Colostomy - PEC procedure. This uses a small standard PEG (Gastrostomy) tube inserted into the sigmoid colon through which I would irrigate enema and water to wash-out the lower bowel whilst sitting on the toilet as normal. I knew immediately this would be much more acceptable to me and decided to go ahead.

The PEC procedure is minimally invasive and can be done under local anaesthetic via colonoscopy and is highly successful. I now irrigate my bowel once a day using one enema followed by 500ml of boiled water. It is quick and easy to use, pain and strain free. It takes 20 minutes from start to finish. The tube is taped neatly to one side when not in use and I hardly know it's there.

The PEC has proved to be a highly successful, minimally invasive surgical procedure which I think is a very attractive alternative to a colostomy for continence."

G.S.

"My problems were caused by childbirth. In 1973 I suffered a third degree tear followed by further damage in 1976 caused by an episiotomy.

Everything was all right until the late 80's-early 90's. I was diagnosed in 1997 as having a hole in the sphincter muscle. If the consultant hadn't had a bowel questionnaire the day of the consultation, I daresay I would still be incontinent. The consultant said the only cure was major surgery.

I was referred back to my local hospital and had an operation called an analplasty, which actually made me worse. I became bowel incontinent 24 hours a day once I had opened my bowels. I plucked up the courage to complain and was told the operation was a success, but they felt I should have 3 months of codeine to constipate me and enemas to make me go. I have a fear of enemas and came home and phoned the Royal London Hospital.

I had physiology tests there and this confirmed I still had the damage. I had a dynamicgraciloplasty in 1999 - major surgery where you have to have a temporary colostomy until the wounds heal. This enabled me to switch myself 'on' and 'off'. When I was 'off', I was continent. But, this wasn't the end of my problems.

Thanks to Incontact, GS rang me. We had similar conditions and we both used enemas. We had both even tried the biofeedback, which we both hated. GS was offered the PEC. I saw her surgeon too, but both he and my consultant were not happy with me having the procedure. But, being a person who does not give up, I contacted the surgeon who pioneered the procedure. He said I was a suitable patient and he referred me to have the operation. My chances were supposedly nil, but my surgeon and I were positive it would work. And it did. I now irrigate twice a day through my PEC and I have my dignity back."

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