Author Wendy Ness is colorectal nurse specialist at Croydon University Hospital. Abstract

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Bowel care/Faeces/Digital removal/Autonomic dysreflexia This article has been double-blind peer reviewed

20 Nursing Times 01.05.13 / Vol 109 No 17/18 / if the patient experiences AD. Nurses need to acknowledge this important area of care, and understand that DRF, DRE and
DRS are nursing roles. They must be able to access theoretical and practical bowel dysfunction training, including that for
DRE and DRF, whether it is within their own trust or provided by an outside agency.
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4, 22-29. Multidisciplinary Association of Spinal Cord Injury Professionals (2012) Guidelines for Management of
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Patient Safety Information Spinal Cord Lesion and
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bowels, such as digital rectal stimulation
(DRS) or transanal irrigation, which reduces the need for DRF and (if appropriate) maybe more acceptable options for the individual.
DRS triggers peristalsis of the left colon. It is performed by the patient or nurse/carer by gently inserting a gloved, lubricated finger into the rectum and slowly rotating the finger in a circular movement against the rectal mucosa. Rotation is continued until relaxation of the bowel wall is felt, flatus passes, stool passes or the internal anal sphincter contracts. It should be continued for 20 seconds then repeated every 5-10 minutes until stool evacuation is achieved (Wiesal and Bell, 2004).
Transanal irrigation with warm water is used to facilitate evacuation of stool from the descending colon and rectum. It can be used in a number of clinical scenarios, such as chronic constipation, faecal incontinence, and obstructive defecation secondary to, for example, a rectocele or neu- rogenic bowel dysfunction (RCN, 2012).
With a wide range of bowel-emptying techniques now available, the need for
DRF is sometimes questioned however it remains imperative in a small group of patients. These patients need seamless care, regardless of the setting. Failure to provide this could result in ineffective bowel management and could even be fatal

Who can carryout drf?
Assessment and legal
When drf is essential

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