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Neurogenic Bowel Management

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Presentation on theme: "Neurogenic Bowel Management"— 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.

4 Aims of Bowel Management
Completed in under one hour minimum necessary physical or pharmacological interventions Individual to the person 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
Reflex defecation centre remains intact Spastic paralysis of the bowel with inability to control defecation Uninhibited reflex activity Individual unable to feel the urge to defecate Cannot control external anal sphincter activity 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 Perform digital rectal examination Insert suppositories, micro-enema or rectal solution Wait for mins Use abdominal massage Reflex bowel action will usually have taken place Perform digital stimulation Await further reflex emptying Repeat digital stimulation every 10 mins until reflex emptying stops A manual evacuation will only be necessary if faeces will not reflex empty

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

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

10 Example of digital rectal stimulation

11 LMN Bowel Lesions below T12 Reflex defecation centre is damaged
Flaccid paralysis Loss of anal tone Lack of tonic external sphincter contraction Ineffective peristaltic movements Individual doesn’t feel the urge to defecate No control over external anal sphincter

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

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

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

15 Complications Autonomic Dysreflexia Constipation Faecal impaction
Diarrhoea Frequent accidents 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 Balance Spasm Old Age Carer intervention Hypotension

21 Hand function Access

22 Equipment Skin Condition

23 Thank You Any questions?

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