Bowel Program adjustments

Bowel Program adjustments

Posted by 12bar on Mar 30, 2016 9:42 am

I've been a t5 complete for about 8 months now, and I'm still adjusting to my bowel routine.  What do most people find to be most effective when a routine produces no results?

I go in the morning, every other day. (usually takes about an hour and a half).  If I have no, or small results, should I try again the next morning, or wait the two days?

Re: Bowel Program adjustments

Posted by AskNurseLinda on Mar 30, 2016 10:11 am

Thank you for bringing this up. You stated you have been at this for eight months. That is a long time but no so much in the time of regulating your bowel program! If you have no results, the general principle is to repeat the next day. The issue to ask is why there are no results. Look critically at your technique. The suppository should be against the wall of the bowel. Digital stimulation should follow in about 10 minutes with dilation of the internal sphincter. That is fairly high up in the rectum. A second digital stimulation follows in another 10 minutes if no results. Check you diet for roughage and add a bulk product to push stool through. You can cut back on the bulk product once the bowel gets regulated.
Keep improving your technique and you will find you will not require the length of time to complete this activity. It does take time to get adjusted to everything, including perfecting the bowel routine. You are on the right path. Nurse Linda

Re: Bowel Program adjustments

Posted by 12bar on Mar 30, 2016 3:03 pm

This is very helpful - thank you.

I have just switched from a suppository to Enimeez (I hear nothing but good about it) so I'm letting my body adjust.  Thios has happend a few times before, but it always sorts itself out in a few days.  I'm worried about balancing the risk of accidents with the risk of over-stimulation.

Re: Bowel Program adjustments

Posted by AskNurseLinda on Mar 30, 2016 4:11 pm

Many individuals use Enimeez with success. It works only in the lower bowel where it is needed.
Whenever you change your bowel program, there is a chance for accidents. However, since the Enimeez empties the lower bowel, it works. The issue becomes if more stool drops into the lower bowel before the next bowel program. You can do a digital check to see if stool is there. There is no guarantee that you will not have an accident but this might relieve your mind. Nurse Linda

Re: Bowel Program adjustments

Posted by Arikestrel on Nov 17, 2017 6:38 pm

Hello,
I guess this fits under the catagory of 'adjustments'. 
I have been a caregiver for a quad for 31 years. C7/T1. Recently, he started prep for his second colonoscopy, just a regular after age 50 type. The first one went very well, that was five years ago. This time, they gave him GoLytly, and it has been a disaster. He did the cleansing routine, only to have his bowels completely stop. He was unable to evacuate even the prep liquids, and it wasn't until the fourth day did he get anything to pass. I was soft but it was less then a quarter cup of material. The doctors in this area have no clue about spinal injuries....anyway, he went back to the gastro enterologist and asked for suggestions. The advice given was take oral Dulcolax in large doses...he did this. Nothing. He then tried some of the local nurse's suggestions, Maalox, prune juice....nothing. He went in to a local surgeon who is a friend of ours and they gave him a catscan and said they didn't see any blockage and sent him home with the advice "get a colonoscopy". !! He is hungry and eats tiny meals, but nothing is happening. His gastro doc has decided to take a couple weeks off, of course, and we don't have anyone else to consult. His stomach is bloated and lopsided. He is drinking as much water as he possibly can... It has been two weeks of this, and the dysreflexia has him resorting to procardia to keep him from having a stroke. I am at wit's end.  My main question is, is there a point in a quad's life when the bowels start becoming more paralized themselves? Is it possible there is some kind of pocket that is getting impacted that they couldn't see on a catscan? What should we be looking for?  I'm afraid he is going to stroke out one night, and even if I get him into the hospital they won't have a clue what to do about it. 

Re: Bowel Program adjustments

Posted by AskNurseLinda on Nov 17, 2017 10:22 pm

Regardless of having a spinal cord injury or not, bowels don't like intrusion. Sometimes they stop working which is called paralytic ileus. It is usually temporary lasting a week or more. Particularly with spinal cord injury, ileus can affect part or all of your bowel and can become permanent. You have to wait until the bowel starts again but not at home. You need medical care and treatment to avoid complications. After some time, the bowel can back up and the person will vomit feces, just flecks at first, then more.

 

If the abdomen is tight, it is called acute abdomen as nothing is moving, including stool and gas or there could be a rupture.

 

In either case, you need a medical work up. Sometimes with little eating, there is little stool but since it has been so long, the problem could be much more severe. An assessment includes listening for bowel sounds with a stethoscope. This can be done by your home health nurse. The presence of bowel sounds is a good sign. A better assessment is the MRI which by your report is fine but you don't say how long ago it was completed. The concern is lack of progress.

 

Another possibility is that the bowel was cleaned and it is just taking some time to get going again. But this is too serious to wait and see. You do have an expert medical opinion but it might be time for an additional assessment.

Always take the Autonomic Dysreflexia card with you so you will have some information for the healthcare team. Her re is the link:

http://s3.amazonaws.com/reeve-assets-production/AD-Guide_adultweb5-16.pdf

Nurse Linda

Re: Bowel Program adjustments

Posted by CGray255 on Dec 16, 2017 10:30 pm

Thanks in advance for any guidance and insight you may have Nurse Linda. I apologize in advance for this long-winded message. 

 

I’m a T11/12 para, 38 years post injury, age 62. I’m experiencing significant issues and problems with my bowel program. I went years and years without worrying about bowel accidents. The rare accident went with the territory. I started experiencing increased bowel accidents about 3 years ago when shoulder deterioration prevented me from participating in regular aerobic cardiovascular exercise, and has gotten progressively worse.  

 

I have a bowel that is mostly reflexive but also has some aspects that seem flaccid in nature too. It seems that my bowel might becoming increasingly flaccid with age, if that’s possible.

 

My routine is: I use 1/3 of a Magic Bullet to initiate my BP every other morning about 1/2 hour after breakfast. That usually produces a 1st pass of Type 3/Type 4 stool that is medium in quantity. After this, I use Valsalva and Digital Stimulation to produce a usually larger amount of Type 4 stool.  I then need to resort to deeper Digital Stimulation and Manual Extraction to remove additional stool that gets increasingly softer, often becoming Type 5 by the time I think I’m finished. It’s hard to tell when I’m actually done because I still feel some pressure in my lower left gut even when I think I’m done. This process can take over a hour from start to finish.  It’s not unusual now for me so smell bowel emanations without flatulence throughout the day. 

 

The problem I’m experiencing is that very often, I experience additional, unexpected bowel incontinence later in the day, sometimes as much as 3 or 4 hours after the BP. This stool is usually Type 5 soft stool too. I also occasionally have accidents on non-BP days too. I now often go back on the toilet later in the afternoon to see if I can pass any additional stool before it passes of it’s own accord. 

 

I have tried several things including changing from a daily BP to my current every other day schedule. This seemed to  have some positive affect at first. At the very least, I was able to have a day off in between these BPs which had become so time consuming and frustrating with the accidents. 

 

The basic essence of my problem seems to be that despite whatever I do, I’m unable to get consistent bulk in my stool throughout my BP and the soft stool is harder to pass, manage, and predict. 

 

I eat very well, 4 times a day, with a total caloric intake of about 1650 calories. I average about 30g of fiber daily with a good balance of soluble and non-soluble intake. At the recommendations of others I take 6 Fibercon a day (eaten 2, 1, 2, 1 with my meals) to add bulk to my stool. That has helped somewhat with the initial passing of stool, but the transition to softer stool as the BP progresses is still the issue.  I do keep an accurate food log and BP notes.

 

My last colonoscopy was 2 years ago and everything internal was fine though my gastroenterologist did comment of some irritation in my rectum which she said was predictable.  My Bowel Transit Time is between 20 to 22 hours. She suggested I could try Imodium proactively to slow my bowel down. I did that and it helped a bit of the front end of the BP but I still had lingering issues with not being able to consistently get all the residual soft stool. I still take Imodium if I experience particularly runny bowels. I have been told that taking it regularly is not good with my solitary kidney, and it wasn’t completely eliminating the problem. 

 

I believe that there must be something in my diet, my BP techniques or routine, or in the changing dynamics of my paralyzed bowel that I’m missing. 

 

So, I’m looking for advice and guidance. I would welcome a full workup with someone who has knowledge and experience with bowel management in aging paras. It seems that this particular issue is somewhere in the area between SCI Rehab docs/nurses and GI docs. I have been unable to locate the expert advice I need.

 

Do you have any recommendations for me that would address any of the issues I’ve explained? Do you have any knowledge of professionals that have expertise in this area that I might consult?

 

Thank you very much. 

 

 

Re: Bowel Program adjustments

Posted by AskNurseLinda on Dec 18, 2017 8:45 am

Hello and thank you for your post. It would seem that you have done everything possible to manage your bowel program. Yes, everyone's, with or without paralysis, bowels become a little more flaccid with aging so you are not alone. There are a few things to try. You might increase your magic bullet to create more stimulus in your bowel function at bowel program time. 1/3 of the magic bullet might not be enough.
When there is soft stool after adding bulk, Ii would wonder if you have added too much bulk making the transit time too swift.
You might even try to change products to stimulate a bowel movement.
Here is the most important thing to do: DO NOT CHANGE MORE THAN ONE THING AT A TIME. Bowels are delicate organs. They will respond to your actions. Changing more than one action at a time will result in more incontinence and possible send you the other way to impaction. Probably, from your email, start by increasing the magic bullet for a month to six weeks, if not successful, cut back on the fiber next, Don't stop it, just cut it down by perhaps a third and see how that goes. A day will not show the effects so after another month or six weeks, try to cut down by a total of one half.  You might notice sooner that you need the fiber so you have to really evaluate your stool quality and then decide but a day or a week might not be enough adjustment time. You will have to really be on top of this to keep your bowel open and not become impacted. Consult with your healthcare professional to get their opinion as well.
Sometimes people get in a trap of doing so much for their bowels that that over medicate as their bowels change with age. It is such a delicate balance that is constantly changing. Nurse Linda

Re: Bowel Program adjustments

Posted by CGray255 on Dec 18, 2017 8:57 am

Thank you Nurse Linda!

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