Interventions

Bowel Management

Interventions

Each person’s bowel program should be individualised, taking into account the diagnosis or nerve damage, as well as other factors.


Establish a routine

  • Take into account pre-injury bowel habits
  • Set up a schedule of either daily or alternate days
  • Take into account the fact that less frequent or irregular bowel management may contribute to constipation
    (Coggrave 2007a)
  • Don’t alter an established routine without clinical reason or advice from a specialist centre.

Most people perform their bowel program at a time of day that fits in with their prior bowel habits and current lifestyle.

The program usually begins with insertion of either a suppository or a mini-enema, followed by a waiting period of approximately 15-20 minutes to allow the stimulant to work. Preferably, this part of the program should be done on the commode.

After the waiting period, digital stimulation is done every 10-15 minutes until the rectum is empty. Those with a flaccid bowel frequently omit the suppository or mini-enema and start their bowel programs with digital stimulation or manual removal.

Bowel programs typically require 30-60 minutes to complete.


Oral and rectal medications

There are a number of different medications that may be used to help with bowel management, such as:

  • Peristaltic stimulants: Senna
  • Stool softeners: Dioctyl, Lactulose
  • Osmotic laxatives: Movicol
  • Bulk formers: Fybogel
  • Suppositories: Glycerine, Bisacodyl Aralax
  • Enemas: Micolette (sodium citrate)

Gastro-colic reflex

This is a reflex response to food or drink entering the stomach, and can help the process of bowel management.

The associated increase in muscular activity throughout the gut can result in movement of stool into the rectum (Harari 2004).

But bear in mind that the response may be reduced or even absent in individuals with spinal cord injury.


Abdominal massage

One of the techniques that can help is to massage the abdomen following the lie of the colon. This helps to promote peristalsis, moving the stool into the rectum and relieving flatulence.


Digital stimulation

This is a technique to increase the reflex muscular activity in the rectum. It is used by 35-50% of individuals with neurogenic bowel dysfunction, and involves gentle circular motion of a gloved, lubricated finger for 20-30 seconds

The process should be repeated every 5 minutes until the bowel has emptied, and can be carried out in a sitting or lying position.


Digital evacuation of faeces

The aim of this process is to break up or remove stools. It is the most commonly used intervention in bowel management, and is associated with shorter duration of bowel care.

It can result in fewer episodes of faecal incontinence and is used in the acute phase when there is no reflex activity present.


Peristeen trans-anal irrigation

Bowel_management13This procedure should be used when conservative management is no longer effective or cannot be established.

All patients must be referred to the bowel clinic for assessment regarding suitability.

If it is approved, the patient will be taught how to use it by a clinic nurse.