Manual for bowel management in persons with spinal cord injury



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M. AKAI


EDITOR
Masami AKAI
National Rehabilitation Center for Persons with Disabilities
CONTRIBUTORS
Kanayo FURUTA
Kayo TOMIOKA
Kyoko YAMANAKA
Hazimu SAKUMA
National Rehabilitation Center for Persons with Disabilities
Tamami TAMURA
Previously worked for the National Rehabilitation Center for Persons with Disabilities
COLLABORATOR
Hisako UCHIYAMA
National Rehabilitation Center for Persons with Disabilities
ILLUSTRATOR
Kazuhiro.i


Preface
Contributors
Introduction……………………………………………………………………………………………………… 1
Chapter…1.
Purpose…of…Bowel…Management…in…Persons…with…Spinal…Cord…Injury… ………………………………… 2 1.…Maintenance…of…a…healthy…life… ………………………………………………………………………… 2 2.…Prevention…of…constipation,…fecal…incontinence,…and…diarrhea… ……………………………………… 2 3.…Prevention…of…decubitus…ulcer… ………………………………………………………………………… 2 4.…Prevention…of…autonomic…hyperreflexia… ……………………………………………………………… 3
Chapter…2.
Structure…of…the…Intestine…and…the…Mechanism…of…Defecation……………………………………………… 4 1.…Structure…of…the…intestine… ……………………………………………………………………………… 4 2.…Mechanism…of…defecation… ……………………………………………………………………………… 4 3.…Types…and…amount…of…stool… …………………………………………………………………………… 5 4.…Types…of…constipation……………………………………………………………………………………… 6
Chapter…3.…
Defecation…Procedures…for…Persons…with…Spinal…Cord…injury… …………………………………………… 8 1.…Procedures…for…smooth…defecation… …………………………………………………………………… 8 2.…Other…procedures……………………………………………………………………………………………11
Chapter…4.
Special…Types…of…Toilets…for…Persons…with…Spinal…Cord…Injury… …………………………………………12 1.…Defecation…with…assistance…………………………………………………………………………………13 2.…Defecation…without…assistance… …………………………………………………………………………16
Chapter…5.
Defecation…in…Bed…… ……………………………………………………………………………………………21 1.…Necessary…materials…for…defecation………………………………………………………………………21 2.…Procedures…… ………………………………………………………………………………………………21
Chapter…6.
Tools…and…Devices…for…Defecation………………………………………………………………………………22
CONTENTS


1.…Suppository…insertion…device………………………………………………………………………………22 2.…Bottom…wiper… ……………………………………………………………………………………………22 3.…Push-up…stand… ……………………………………………………………………………………………22 4.…Specialized…clothes… ………………………………………………………………………………………23 5.…Toilet…seat……………………………………………………………………………………………………23 6.…Soft…toilet…seat… ……………………………………………………………………………………………23 7.…Footrest………………………………………………………………………………………………………24
Chapter…7.
Diet…and…Defecation………………………………………………………………………………………………25 1.…Recommended…food…and…drinks…against…constipation… ………………………………………………25 2.……Food…and…drinks…likely…to…cause…fecal…incontinence…and…diarrhea,…and…dietary…suggestions… …26
Chapter…8.
Medications… ……………………………………………………………………………………………………28
Chapter…9.
Going…out…and…Staying…out………………………………………………………………………………………30 1.…Prior…defecation… …………………………………………………………………………………………30 Meals 3.…What…to…bring… ……………………………………………………………………………………………30 4.…Coping…with…fecal…incontinence……………………………………………………………………………30 5.…Preliminary…check……………………………………………………………………………………………31
Cited…References…and…References………………………………………………………………………………32


1
Introduction
Many patients with spinal cord injury are admitted to our center for rehabilitation. One of the symptoms of spinal cord injury is dyschezia. These patients experience constipation, fecal incontinence, and diarrhea that cause discomfort and restrict their life activities. Therefore, they stay at our center to, first, regain the habit of regular bowel movements and, second, to be able to develop bowel management. Persons with paralyzed limbs and/or muscle weakness have difficulties in transferring to a standard toilet. These persons can choose the most comfortable approach for their defecation by improve toilet environment. In addition, it is important to understand the appropriate diet, fluid intake, and medications factors related to defecation—for such individuals.
This manual provides extensive information on bowel management in persons with spinal cord injury and explains the purpose of bowel management, defecation mechanism, defecation procedures, improvement of toilets, and other related issues. We hope that persons with spinal cord injury, caregivers, or medical and health-care professionals will find this manual useful.

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