Quadriplegics bowel routine current practice

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    Not being the most glamorous subject to research, there's not a wealth of information out there about this subject. Is manual disempaction a necessary evil or is it old school. Just to be clear, theses are people who lack the necessary motility to evacuate their bowel on their own. They must have assistance to empty their bowel in order to prevent obstruction or autonomic dysreflexia. Are drugs the way to go or should a specific procedure be used as maintenance.

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  2. 8 Comments...

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    When I worked on a SCI unit, we had a 3-2-1 or 2-2-1 rule including mechanical removal, depending on where the injury was, if they had sensation, chance for function to return, etc. 3 is three Sennas or 2 Sennas, 2 colace, 1 for suppository or enema. Senna is for bulk and water, Colace is to facilitate passage, the suppository or enema if to produce evacuation. The menchanics of vagal stimulation or removal of stool ensures that the stool is successfully removed. The purpose is to prevent autonomic dysreflexia, so a well managed bowel routine is NECESSARY, not optional. So now you know the WHY...you kind of answered you question, but at least getting my explanation, and checking your facility's policy, can determine the clinical decision you make. Remember, autonomic dysreflexia is a CRITICAL EMERGENCY...it's a complication that I would suggest you would want to AVOID in your pt. HTH!
    TheCommuter and Sally Lou like this.
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    Are the meds better off being given every day or every 2nd or 3rd day? if enemas or supps are given, is manual disimpaction necessary?
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    I think a regular schedule of manual feces removal is a fact of life for most quadriplegics. If they truly lack bowel motility, no amount of colace or senna will work with some degree of manual disimpacting.
    Sally Lou likes this.
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    Quote from Roboapple
    Are the meds better off being given every day or every 2nd or 3rd day? if enemas or supps are given, is manual disimpaction necessary?
    Colace and senna should be given every day. Suppositories every 2 or 3, depending on the pt.

    And, yes, even after a suppository is given, the nurse must manually remove the feces. Or at least feel to see if there's any more stool up there that needs to come out.
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    Quote from Roboapple
    Are the meds better off being given every day or every 2nd or 3rd day? if enemas or supps are given, is manual disimpaction necessary?
    Manual Disimpaction is necessary; it's a part of assessment to make sure the stool is not impacted, as Brandon mentioned. The medication regiment is replacing the body's natural process of facilitating, movement, and evacuation of stool. The regimen will depend on the pt, and the orders may be different, but the manual removal still is needed, as well as decrease the chances of AD.
    ceebeejay likes this.
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    Check out myshepherdconnection.org
    Lots of fantastic resources about SCI and a section specifically regarding bowel programs
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    When I worked SCI, every patient received Senokot BID. The level of injury depended on whether they got a suppository, and most got them nightly. Our routine was suppository in bed, wait 30 minutes then up. We always gave them the opportunity to let stool pass on it's own, but never considered it done til we did dig stim to ensure they were empty. Towards the end some would go to QOD bowel programs because they had little stool when some daily and that was going to be their routine at home.
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    Husband has been a high level quad almost 42 years and has done all of the above with varying degrees of success. When we married I asked if he minded trying just nightly manual digital stim and removal an hour after eating, laying on his side and he has done better with no accidents for 18 years. A welcome relief for him with a routine that takes only 10-20 minutes without unpredictable results hours later or even the next morning. I will say he is a model of hydration, drinking at least a gallon of water a day and 2 oz of real lemon juice (unsweetened) for bowel and bladder motility.
    bridgetteRN likes this.


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