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



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Keywords:
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 / www.nursingtimes.net 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.
NT
References
Association for Continence Advice (2011)
Guidance for End of Life/Palliative Continence
Care. Bathgate: ACA.
Coggrave M (2010) Guidelines for neurogenic bowel management after spinal injury better management of neurogenic bowel dysfunction supplement. Gastrointestinal Nursing; 8: 2, Department of Health (2009) Reference Guide to
Consent for Examination or Treatment. London DH. tinyurl.com/dh-consent2
Foxley S (2009) Bowel care for patients with long-term chronic conditions. Continence UK; 3:
4, 22-29. Multidisciplinary Association of Spinal Cord Injury Professionals (2012) Guidelines for Management of
Neurogenic Bowel Dysfunction in Individuals with
Central Neurological Conditions. www.mascip.co.
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National Reporting and Learning Service (2004)
Patient Safety Information Spinal Cord Lesion and
Bowel Care. tinyurl.com/spinalcord-bowelcare
Nursing and Midwifery Council (2008) The Code
Standards of Conduct, Performance and Ethics for
Nurses and Midwives. London NMC. www.nmc-uk.
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Royal College of Nursing (2012) Management of
Lower Bowel Dysfunction, Including DRE and DRF:
A Guidance for Nurses. London RCN.
Wiesal P, Bell S (2004) Bowel dysfunction assessment and management in the neurological patient. In Norton C, Chelvanayagam S (2004)
Bowel Continence Nursing. Beaconsfield:
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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).
Conclusion
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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