2Aims of Bowel Management Reflex or Flaccid?Transanal IrrigationWho?When?Where?
3Aims of Bowel Management Regular and predictable emptying at a socially acceptable time and place, avoiding constipation unplanned evacuations and autonomic dysreflexia.
4Aims of Bowel Management Completed in under one hourminimum necessary physical or pharmacological interventionsIndividual to the personComfort, safety, privacy, dignity
5Neurogenic Bowel Function Reflex or flaccid?Reflex – T12 or aboveFlaccid – L1 or below
6UMN Bowel Lesions at T12 and above Reflex defecation centre remains intactSpastic paralysis of the bowel with inability to control defecationUninhibited reflex activityIndividual unable to feel the urge to defecateCannot control external anal sphincter activityRectal contractions to expel the stool are blocked by external sphincter contracting at the same time
7Management of the UMN bowel Warm drink and something to eat mins before you startPerform digital rectal examinationInsert suppositories, micro-enema or rectal solutionWait for minsUse abdominal massageReflex bowel action will usually have taken placePerform digital stimulationAwait further reflex emptyingRepeat digital stimulation every 10 mins until reflex emptying stopsA manual evacuation will only be necessary if faeces will not reflex empty
11LMN Bowel Lesions below T12 Reflex defecation centre is damaged Flaccid paralysisLoss of anal toneLack of tonic external sphincter contractionIneffective peristaltic movementsIndividual doesn’t feel the urge to defecateNo control over external anal sphincter
12Flaccid Bowel Management Daily or twice daily at regular timesBristol Scale 2 to 3Laxative 8 to 12 hours before
13Flaccid Bowel Management Hot food or drink 20 to 30 minutes beforeDigital removal of faecesDigital check to see if evacuation is complete
14Stimulants used on the G. I. tract Osmotice.g MovicolStimulantse.g SennaSoftenerse.g. DioctylBulk forming agentse.g. FibogelSuppositoriese.g. Bisocodyl, GlycerineMicro-enemase.g. Microlax