Manual for bowel management in persons with spinal cord injury



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4. Types of Constipation
There are 2 types of habitual constipation in persons with spinal cord injury.
i. Rectal constipation
No defecation reflex is induced although stools move down to the rectum.
ii. Colonic constipation
Stool cannot be pushed out because of poor intestinal movement in many cases and because of reduced straining strength.
Table 1: Defecation record
Month/Day
Time
Medication
Others
Amount
Bristol Stool Chart type
Defecation procedure
February/6 9:30–10:30 2 Pursennid tablets at 21:00 the previous day
In bed
200g
3 3 Suppositories, disimpaction
February/9 In bed
200g
3 3 Suppositories, disimpaction
February/12 Wheelchair toilet
100g
3
Disimpaction
Month/Day
:–:

The treatment procedures for constipation depend on whether the stool moves down to the rectum. First, the presence of stool should be confirmed by inserting a finger into the rectum. Before the procedure, a rubber glove should be worn on the dominant hand and lubricants such as petrolatum and olive oil should be placed on the finger to be inserted.
If the absence of stool is thus confirmed, suppositories and enemas would notwork. Therefore, intestinal movement needs to be improved by using cathartic drugs and other stimulants methods. If stool is present in the rectum, taking stimulant cathartics might cause diarrhea however, it is necessary to induce easy evacuation of stool. Procedures for this type of constipation include knowing the timing of when the stool reaches the rectum, maintaining a position for easy defecation, stimulating the anus with a (warm) water wash while seated on the toilet seat, directly stimulating the rectum with a finger, and performing disimpaction and enema. The defecation cycle depends on each individual. Efficient bowel movement can be ensured by understanding the cycle of when the stool moves down to the rectum, allowing timely defecation on the basis of this cycle
3)

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