Bowel Management

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Manual Evacuation
Manual evacuation aims to empty the rectum with the fingers, this is usually described as the digital removal of faeces‘. This procedure can be carried out either on the bed, commode or toilet. We will teach you how to do this. If you do this in bed it is better to lie on the side that leaves your dominant hand free with your uppermost knee bent up slightly and resting over your lower leg.

Wash your hands.

Make sure your fingernails are trimmed, as they can puncture the glove and damage the rectum.

Put on gloves.

By slowly and gently pushing against the anal sphincters, insert a well-lubricated gloved finger (e.g. KY jelly, one to two inches gently into the rectum toward the bellybutton Use one or two fingers to breakup or hook stool and gently remove it from your rectum.

Continue to remove the stool until you cannot feel or reach any stool in the bowel. You can help this technique by using your abdominal muscles to bear down. This helps push the stool towards the rectum and is called the valsalva manoeuvre.
Bowel diary A bowel diary is the recording of your daily bowel function. You can use it to collect information on your bowel habit. You may find this useful if you are having problems with your bowel routine. You should record important details such as

Any assistive techniques (such as gastrocolic response, Valsalva).

Stimulation method used (digital or chemical rectal stimulation.

Exact timing and regularity of your bowel habit (from first stimulation to routine completion.

Stool amount and consistency.

Any problems with your bowel, such as unplanned bowel movements etc.

Comments about your diet (fibre amount.

Your daily fluid intake.

Your activity level.

Your current medication. All this information will help you during your stay at the local spinal injuries unit and at home. However, when spinal cord injured people are admitted to general hospitals or when they go back to their local community, they can face problems maintaining their routine bowel care. Ward nurses or district nurses might refuse to perform manual evacuation or may want to change this part of your bowel care. A nurse unfamiliar with manual evacuation may need additional information and training. Different issues that may need to be addressed

Only a trained person should perform a manual evacuation.

If the nurse has never been shown how to do it, you may suggest that they consult their own nurse manager to get the opportunity to learn how to do it.

If the nurse refuses to do a manual evacuation claiming it is illegal, you must explain that this procedure is not illegal and suggest that they should consult the Nursing and
Midwifery Council for
, Professional Code of Conductor the Royal College of Nursing document entitled Digital rectal examination and removal of faeces.

If the nurse prefers to change your bowel care thinking manual evacuation is inappropriate, you should ask them to consult your GP or your local spinal injury unit first.

You should tell them that inappropriate adjustment or avoidance of your established

Managing your bowels
The science bit
Upper motor neuron or reflex bowel
Lower motor neuron or flaccid hypotonic bowel
Coffee, tea, cocoa or soft drinks
Other factors
Performing bowel care
Medication stimulant laxatives
Osmotic laxatives

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