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Type of bowel
If you have an upper motor neurone spinal cord lesion you should have a reflex bowel. A reflex bowel should, if carried out appropriately, respond well to the insertion of suppositories and correct digital stimulation technique, followed by a manual evacuation (if appropriate). Some reflex bowels will empty on reflex and will only then require a PR check to ensure the rectum is empty. If it is not empty, and there are stools present, then a manual evacuation should be performed.
If you have a lower motor neurone spinal cord lesion you should have a flaccid bowel. A flaccid bowel should be managed by carrying out manual evacuations at regular intervals, eg daily or alternate days.
NB: it is possible to have a ‘mixed’ bowel, which will require both digital stimulation and manual evacuation
Timing of bowel care
It is vital that you decide the time of day to carry out bowel care, and that you keep to this (ie mornings or evenings, not a mixture of both). It is not possible to establish a good routine by frequently changing the timing of bowel care. It is necessary to carry out bowel care daily or on alternate days. This needs to be decided and kept to.
Establishing a routine
It can take at least 2 weeks to get bowels into a good routine and therefore you need to persevere with your regime, even if in the early days you do not feel it is working. If you feel you need to change an aspect of your bowel management it is best to change one thing at a time, and to ‘run with it’ for two weeks. This will help you to decide if it is working or not. It is also advisable to seek advice about what to change in your regime.
Handy Hints
- Have a hot drink prior to bowel care and something to eat. This helps the gastro-colic reflex to work.
- It is possible to take too much fibre in your diet which can be detrimental to your long-term results.
- Gravity helps the bowels to work, so if you are able to, sit on a padded shower chair over a toilet, or sit directly on the toilet (if the seat is padded).
- Laxatives may seem to help at first but it is likely that you will become ‘immune’ to them and will then need to turn to even stronger ones. You are therefore advised not to take strong laxatives, either by mouth or by inserting them into the rectum eg strong suppositories or enemas. These are often the reason for incontinence. Please seek advice before attempting to use these.
- There is usually a reason for a bowel regime suddenly becoming erratic. Please seek advise if this happens.
Digital Stimulation and Manual Evacuation
Insert 2 Gylcerin Suppositories into the rectum and leave in place to work for at least 30 minutes. NB the suppositories must be placed so that they are in contact with the rectal wall and not amidst stools.
After 30 minutes, carry out digital stimulation. Insert a lubricated gloved finger into the rectum, and slowly rotate the finger maintaining contact with the rectal wall at all times. Rotate for 1 minute then remove finger. Repeat this every 3-5 minutes for a minute each time. Do not repeat more than 5 times.
Each time a finger is inserted into the rectum (to carry out stimulation) remove any stools by manual evacuation. This is carried out by gently hooking the finger around a stool and easing it out of the rectum. Continue to do this until all stools are removed.
5 minutes after completing the final digital stimulation, carry out a PR check and remove any stools that are present.
If you require any further advice please contact:
Wendy Slater, Out-patient Sister 01722 429291
