Techniques of defecation

Emptying the bowel should occur periodically (every one or two days) possibly around the same time. Doing so trains the bowel and therefore allows you to maintain or regain control over defecation.

Habits

You can help to regulate your bowel movements by paying careful attention to your habits and activities. Do you normally always empty your bowel in the morning? Or do you prefer to go to the toilet in the evening if there is sufficient time? What types of food aid your digestion? How do drinks affect your digestion? Activities such as exercise and regular movement also affect your digestion and the rhythm of your bowel movements. Therefore, you should bear this in mind. Emptying your bowel is a very personal thing. For example, stress or travel also have a significant effect on a person’s digestion.

If the problems recur, keeping a record of bowel movements may be helpful for the assessment of the situation.

Techniques and methods of bowel management

There are various techniques for emptying the bowel.

• Digital stimulation of the rectum (only for the spastic bowel)
  The defecation reflex can be triggered by gentle rotating movements and soft pressure against the rectal wall (min. 30 seconds), using the index or middle finger.
• Digital defecation (clearing of bowel)
  In the case of digital defecation, the rectum is cleared manually using the index or middle finger.
• Digital control of the rectum (checking with finger)
  Checking the rectum should be done to find out whether it is empty, usually after defecation. Due to a loss of sensibility and therefore the incapacity to feel the amount of fullness, the rectum should also be checked before defecation. Rotating movements should be avoided when checking the rectum since this may trigger the defecation reflex.

Supporting measures

Emptying the bowel should ideally be done in a sitting position on the toilet or shower wheelchair since gravity supports the process. It is important to be in a relaxed sitting position and that the feet are not dangling in the air but placed on a supporting surface.

If defecation needs to be performed in bed, it is recommended to lie on your left side since the progression of the large intestine facilitates emptying in this position.

Abdominal press

Activating the abdominal muscles may be used supportively for the defecation procedure. Normal stool consistency is necessary however. If the abdominals cannot be activated due to the lesion level, the following options exist for easing defecation:

• Bending forward with the upper body
• Pressing with the hands on the lower abdomen

It is advisable to ascertain the reason for the pressure on the bladder beforehand. Pressing on the abdomen also increases the pressure in the bladder, which affects bladder management.

Massaging the colon

A colon massage is a massage of the abdominal cavity. It can be applied in a lying or sitting position and has a supportive effect after using a suppository or in the case of digital stimulation of the rectum.

• Massage clockwise since this is the direction of the bowel movement
• Begin on the lower left side of the abdomen in the descending large intestine.
• By applying gentle pressure with the palm of your hand, the stool is pushed towards the rectum.
• Slowly progress up the left side of the abdomen (always pushing in the direction of the anus), then from the horizontal part of the colon to the ascending colon on the right side of the abdomen.
• Massaging the colon takes about 10 to 20 minutes.

Giving a suppository

• Warm up the suppository slightly by rubbing it with your fingers, or moisten it with water (Lecicarbon®) for better gliding. You should not use Vaseline or similar products since this lessens the effect.
• Put the suppository between the stool and the rectum wall. If the rectum is already filled with hard stool, first clear it digitally.
• Give the suppository the necessary time to work; defecation should take max. 30 minutes.

Tips

• When attempting to empty their bowel in a seated position, the person’s feet must be placed firmly on the ground in order to relieve the strain on their pelvis.
• In order to avoid pressure sores, the toilet seat or shower chair should ideally be cushioned.

Special bowel-emptying measures

Bowel irrigation

Bowel irrigation is a technique for emptying the bowel if the conventional method of defecation with a suppository does not lead to a satisfactory outcome, if defecation takes too long (over 30 min.) or if continence cannot be achieved.

Bowel irrigation is a form of colonic irrigation. With bowel irrigation, a catheter is inserted into the anus and water at body temperature is then pumped into the bowel. The water causes the bowel to be expanded gently, stimulating bowel movements which transport the stool to the anal opening. Bowel irrigation must be done in a sitting position on the toilet or shower wheelchair. Nowadays, there are various all-in-one systems available for bowel irrigation, making the application easier.

If you are unhappy with your bowel management, contact your outpatient spinal cord injury unit.