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Neurogenic Bowel Management Arlene Wilde – Specialist Nurse Spinal Injuries.

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Presentation on theme: "Neurogenic Bowel Management Arlene Wilde – Specialist Nurse Spinal Injuries."— Presentation transcript:

1 Neurogenic Bowel Management Arlene Wilde – Specialist Nurse Spinal Injuries

2 Aims of Bowel Management Reflex or Flaccid? Transanal Irrigation Who?When?Where?

3 Aims of Bowel Management Regular and predictable emptying at a socially acceptable time and place, avoiding constipation unplanned evacuations and autonomic dysreflexia. Regular and predictable emptying at a socially acceptable time and place, avoiding constipation unplanned evacuations and autonomic dysreflexia.

4 Aims of Bowel Management Completed in under one hour Completed in under one hour minimum necessary physical or pharmacological interventions minimum necessary physical or pharmacological interventions Individual to the person Individual to the person Comfort, safety, privacy, dignity Comfort, safety, privacy, dignity

5 Neurogenic Bowel Function Reflex or flaccid? Reflex – T12 or above Flaccid – L1 or below

6 UMN Bowel Lesions at T12 and above Lesions at T12 and above Reflex defecation centre remains intact Reflex defecation centre remains intact Spastic paralysis of the bowel with inability to control defecation Spastic paralysis of the bowel with inability to control defecation Uninhibited reflex activity Uninhibited reflex activity Individual unable to feel the urge to defecate Individual unable to feel the urge to defecate Cannot control external anal sphincter activity Cannot control external anal sphincter activity Rectal contractions to expel the stool are blocked by external sphincter contracting at the same time Rectal contractions to expel the stool are blocked by external sphincter contracting at the same time

7 Management of the UMN bowel Warm drink and something to eat mins before you start Warm drink and something to eat mins before you start Perform digital rectal examination Perform digital rectal examination Insert suppositories, micro-enema or rectal solution Insert suppositories, micro-enema or rectal solution Wait for mins Wait for mins Use abdominal massage Use abdominal massage Reflex bowel action will usually have taken place Reflex bowel action will usually have taken place Perform digital stimulation Perform digital stimulation Await further reflex emptying Await further reflex emptying Repeat digital stimulation every 10 mins until reflex emptying stops Repeat digital stimulation every 10 mins until reflex emptying stops A manual evacuation will only be necessary if faeces will not reflex empty A manual evacuation will only be necessary if faeces will not reflex empty

8 Reflex Bowel Management Alternate days, regular times Alternate days, regular times Bristol Scale 4 Bristol Scale 4 Stimulant laxatives 8 hours before Stimulant laxatives 8 hours before Hot food or drink 20 – 30 minutes before Hot food or drink 20 – 30 minutes before

9 Reflex Bowel Management Suppositories/enema Suppositories/enema Digital rectal stimulation Digital rectal stimulation Digital removal of faeces if required Digital removal of faeces if required Digital rectal check to see if evacuation is complete Digital rectal check to see if evacuation is complete

10 Example of digital rectal stimulation

11 LMN Bowel Lesions below T12 Lesions below T12 Reflex defecation centre is damaged Reflex defecation centre is damaged Flaccid paralysis Flaccid paralysis Loss of anal tone Loss of anal tone Lack of tonic external sphincter contraction Lack of tonic external sphincter contraction Ineffective peristaltic movements Ineffective peristaltic movements Individual doesnt feel the urge to defecate Individual doesnt feel the urge to defecate No control over external anal sphincter No control over external anal sphincter

12 Flaccid Bowel Management Daily or twice daily at regular times Daily or twice daily at regular times Bristol Scale 2 to 3 Bristol Scale 2 to 3 Laxative 8 to 12 hours before Laxative 8 to 12 hours before

13 Flaccid Bowel Management Hot food or drink 20 to 30 minutes before Hot food or drink 20 to 30 minutes before Digital removal of faeces Digital removal of faeces Digital check to see if evacuation is complete Digital check to see if evacuation is complete

14 Stimulants used on the G. I. tract Osmotic Osmotic e.g Movicol e.g Movicol Stimulants Stimulants e.g Senna e.g Senna Softeners Softeners e.g. Dioctyl e.g. Dioctyl Bulk forming agents Bulk forming agents e.g. Fibogel e.g. Fibogel Suppositories Suppositories e.g. Bisocodyl, Glycerine e.g. Bisocodyl, Glycerine Micro-enemas Micro-enemas e.g. Microlax e.g. Microlax

15 Complications Autonomic Dysreflexia Autonomic Dysreflexia Constipation Constipation Faecal impaction Faecal impaction Diarrhoea Diarrhoea Frequent accidents Frequent accidents Haemorrhoids Haemorrhoids

16 Transanal Irrigation

17 Who? – Patient or Nurse/Carer?

18 When? – Twice daily, daily, alternate days ?

19 Where? – Toilet or Bed?

20 Ability to transfer Ability to transfer Balance Balance Spasm Spasm Old Age Old Age Carer intervention Carer intervention Hypotension Hypotension

21 Hand function Hand function Access Access

22 Equipment Equipment Skin Condition Skin Condition

23 Thank You Any questions?


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