Digital Stimulation PURPOSE: To stimulate peristalsis and aid in defecation for the individual with a neurogenic bowel.

ESSENTIAL STEPS IN PROCEDURE 1. Wash hands. 2. Explain procedure. 3. If in bed, turn individual on left side, if possible and place incontinent pads under buttocks. 4. If the individual can be up in a chair, place on well padded commode chair and place over the toilet. 1. Handwashing is considered the single most important procedure in preventing cross- contamination. 2. To alleviate anxiety and elicit cooperation and begin teaching. 3. Place pillow to back and between knees to assist in keeping in position. 4. The force of gravity will aid in moving the intestinal contents. KEY PONTS

5. Insert gloved, lubricated finger gently through the anal sphincter. 6. Move finger in a circular motion slowly and gently. 7. Make this circular motion for 30 seconds or longer until stool is felt against the finger and the sphincter muscles begin to relax. Wait several minutes; repeat this step until no stool is felt in the rectum. 5. Be gentle and use plenty of lubricant. 6. Stimulates rectal contraction. 7. The length of time varies depending on how tight the sphincter muscles are, or how spastic the individual, whether there is stool present in the rectum, and the individual pattern of the individual. ESSENTIAL STEPS IN PROCEDURE KEY PONTS

8. Wait 3-4 minutes and recheck/stimulate again if stool in vault. 9. The individual may be instructed to hold his/her breath and push or cough. 10. Cleanse as indicated. 8. A mucous return and a closed internal sphincter signify completion of the procedure. 9. Pressure in the rectum can be raised by use of these measures. Massaging with the hands over the lower abdomen may help evacuate the bowel. ESSENTIAL STEPS IN PROCEDUREKEY PONTS

11. Position patient for comfort. 12. Remove and discard soiled supplies & equipment. 13. Dispose of equipment in appropriate waste receptacle. 13. Waste material contaminated with feces may be disposed of in regular trash receptacle, however, if blood is present, material must be disposed of as infectious waste. ESSENTIAL STEPS IN PROCEDUREKEY PONTS

14. Wash hands. 15. Record procedure and results on Bowel Care Record. 16. Report any abnormalities or problems to nurse or doctor as indicated, and/or on Progress Notes as appropriate. 14. Handwashing is considered the single most important procedure in preventing cross- contamination. ESSENTIAL STEPS IN PROCEDUREKEY PONTS