A cecostomy button is a small medical device providing direct access into the large intestine, specifically the cecum. This minimally invasive intervention offers a long-term solution for managing severe bowel dysfunction that has not responded to traditional oral or rectal treatments. It allows for the administration of a cleansing fluid, known as an antegrade enema, which flushes the colon from above, providing predictability and control over bowel movements.
Understanding the Cecostomy Button Device
The cecostomy button is a low-profile device, often resembling a small, flat cap that sits flush against the abdominal skin. Unlike a traditional stoma, which involves an external pouch to collect waste, the button creates a closed system accessed only during the flushing routine. The device is inserted into a surgically created passage, or tract, leading from the skin surface directly into the cecum.
The button is held securely in place by an internal retention mechanism, which prevents it from falling out of the tract. This mechanism is typically either an inflatable balloon or a coil-like bolster feature. The external component features a small port that accepts a detachable extension set only when the enema is administered. This design ensures the access point remains closed and unobtrusive.
Medical Conditions Requiring the Button
The primary reason for cecostomy button placement is the treatment of chronic, intractable constipation and fecal incontinence that has failed multiple conservative therapies. Patients are considered candidates when oral laxatives, suppositories, and standard rectal enemas prove ineffective in achieving predictable continence.
A significant number of recipients have a neurogenic bowel, a dysfunction commonly associated with conditions like Spina Bifida. Nerve damage prevents the colon muscles from effectively moving stool, leading to severe retention and overflow incontinence. Other conditions include complex anorectal malformations and certain severe motility disorders. The antegrade flushing method offers a comprehensive way to clean the entire colon, a process often impossible with retrograde enemas.
Routine Flushing and Site Management
The core of cecostomy care involves the daily administration of the antegrade enema solution through the button. Before starting, the person should be positioned comfortably, typically sitting on a toilet, to allow the flushed contents to be easily expelled. The extension set is attached to the button, and the enema solution flows into the cecum, usually by gravity from a hanging bag. The solution used for flushing can vary but often includes saline, tap water, or a combination of water mixed with a stimulant like glycerin or a phosphate enema solution, as directed by a healthcare provider. The entire process, from administration of the fluid to the completion of the bowel movement, generally takes about 30 to 60 minutes.
Proper care of the peristomal skin around the button site is equally important to prevent irritation and infection. The skin should be cleaned daily using mild soap and warm water, gently wiping away any mucus or drainage that may accumulate. A soft washcloth or cotton swab is suitable for this cleaning process, and the area should be patted completely dry afterward. Caregivers should avoid applying creams, lotions, or powders to the skin around the site unless specifically instructed by a medical professional, as these can trap moisture or damage the button material.
Recognizing and Addressing Common Issues
Several non-emergency issues can arise with cecostomy buttons, the most common being leakage around the device. Leakage often signals that the colon is not being emptied completely, leading to pressure that forces stool or irrigation fluid out around the button. It can also indicate that the balloon holding the button in place is deflated or that the tract has slightly widened. Troubleshooting this involves ensuring complete bowel evacuation during the flush and checking the integrity of the retention balloon.
Another frequent concern is the development of granulation tissue, which appears as raised, red, moist tissue around the button’s exit site. This is a common and usually harmless buildup of scar tissue that occurs as the body tries to heal the opening. While it can cause minor bleeding or drainage, treatment often involves the topical application of silver nitrate by a healthcare provider to shrink the excess tissue.
The most time-sensitive issue is the accidental displacement or removal of the cecostomy button. If the button falls out, the tract connecting the skin to the cecum can begin to close rapidly, sometimes within hours. In this scenario, it is imperative to immediately insert a temporary replacement device, such as a spare button or a Foley catheter, into the tract to maintain the opening’s size. The replacement device should be secured and the clinical team contacted immediately for a prompt replacement of the correct button.