Post by DJ on Jul 4, 2013 12:32:02 GMT -8
Methods of Bowel Management and Care
The primary purpose of establishing an effective bowel management program, or bowel routine, is to allow the individual to minimise the risk of bowel accidents, and organise an acceptable time for the bowel to be emptied in a safe manner.
All people with a spinal cord injury have the potential for involuntary bowel movements, due to the lack of sensation, and the inability to sense when the rectum is full. On average, around 11% of individuals with a chronic spinal cord injury, suffer one or more accidental bowel movements per week.
Many people with spinal cord injuries, regard accidental bowel movements as one of the most distressing aspects of their post injury lives. Bowel accidents can have an impact on self confidence, impact social life and reduce recreational activities, as well as having a negative impact of educational and employment opportunities.
Minimising accidental bowel movements, is therefor a high priority in improving the quality of life for those affected by spinal cord injuries.
Management of the Reflex Bowel or Upper Motor Neuron Bowel
In a person with a reflex bowel dysfunction, the bowel reflex can be utilised to evacuate the bowel of faeces by using chemical rectal stimulation, digital rectal stimulation, or a combination of both.
A similar process of bowel evacuation in a reflex or upper motor neuron bowel, is recommended in most spinal cord injury centres as follows (From: Ash 2005):
1. Digital Rectal Examination - Digital removal of some faeces may be necessary if the rectum is already full, so that sufficient space is created to enable the rectal stimulant to achieve maximum contact with the rectal wall for best effect.
2. Insert Prescribed Rectal Stimulant - Suppositories or micro enemas which need to be left in situ for an appropriate period of time to deliver effective stimulation.
3. Digital 'Rectal Checking' - To assess the completeness of reflex evacuation.
4. Digital Rectal Stimulation - To trigger further evacuation. The established bowel routine programme should stipulate a minimum and maximum period of digital rectal stimulation.
5. Repeat Stages 3 and 4 - Until rectum is empty.
Management of the Flaccid Bowel or Lower Motor Neuron Bowel
In a person with a flaccid bowel, the stool tends to be hard. This can help in the bowel management, as it reduces the risk of accidental bowel movements due to the requirement of digital removal. As the external anal sphincter is open in a lower motor neuron bowel, a hard stool is less likely to be forced out of the rectum, than an upper motor neuron stool consistency.
Because there is no reflex in the bowel, chemical stimulants do not work, and so the principle method of bowel evacuation, is the use of digital rectal stimulation. In digital rectal stimulation, a gloved finger is inserted into the rectum via the anal canal. If faeces are detected, they are carefully removed by using a circling action of the finger.
A bowel routine can be very time consuming, and over 40% of people with a chronic spinal cord injury, spend over an hour on their routine. An acceptable time of no longer than an hour is the accepted target for a bowel routine.
The period between bowel movements can vary, but the generally accepted times are every other day for a reflex bowel, and once a day for a flaccid bowel. If the time periods are increased between bowel movements, then bowel accidents can occur, as well as constipation, impaction and in those with a spinal cord injury above T6, autonomic dysreflexia.
One of the most important factors in preventing bowel accidents is to keep to a routine. This routine also includes diet, and part of a healthy bowel routine is a healthy diet.
Info sourced from here.