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Healing sores and using the toilet

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    #16
    So today my Dad tried bowels in bed, on his left side. It was .... messy. I tried to cover the wound with a piece of Telfa held on by paper tape over Silvadene (antibiotic). And it got covered in soft stool and was totally contaminated. Since the wound is on his left cheek very close to the midline/anus, soft stool smears on it as it falls down. This doesn't happen over the toilet, thanks to gravity.

    Should we try having him lie on his right side instead?

    Can anyone share any pointers/tricks for doing bowels in bed? How they position? How to help keep the pelvis up / place chux / clean up well etc.. Any input is appreciated.
    Last edited by hlh; 4 Oct 2020, 11:19 PM.

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      #17
      I did mine on my right side for a couple weeks healing a wound in my left cheek. It was mildy uncomfortable but worked. I also coated my right cheek and small wound with vaseline to act as a skin barrier and to aid in clean up. I dunno if that's good or bad for bad open wound, probably not great, but a blob of petroleum jelly on my little spot kept it isolated from everything going on.
      "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

      "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

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        #18
        Originally posted by Oddity View Post
        I did mine on my right side for a couple weeks healing a wound in my left cheek. It was mildy uncomfortable but worked. I also coated my right cheek and small wound with vaseline to act as a skin barrier and to aid in clean up. I dunno if that's good or bad for bad open wound, probably not great, but a blob of petroleum jelly on my little spot kept it isolated from everything going on.

        That's really useful. Thank you!

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          #19
          bowel programs in bed should be done with lots of chux pads, bowel stimulant like a suppository or mini enema and patience. http://rehab.washington.edu/patientc...sci_bowels.asp

          pbr
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


            #20
            Originally posted by hlh View Post
            So today my Dad tried bowels in bed, on his left side. It was .... messy. I tried to cover the wound with a piece of Telfa held on by paper tape over Silvadene (antibiotic). And it got covered in soft stool and was totally contaminated. Since the wound is on his left cheek very close to the midline/anus, soft stool smears on it as it falls down. This doesn't happen over the toilet, thanks to gravity.

            Should we try having him lie on his right side instead?

            Can anyone share any pointers/tricks for doing bowels in bed? How they position? How to help keep the pelvis up / place chux / clean up well etc.. Any input is appreciated.
            PM sent (sorry for the delay in reply). What may help is to put something on the wound before transferring to bed to perform this. There are a lot of fantastic dressings that will contour perfectly and move along with the positioning of this body so you don't have to worry about soiling the wound.
            No one ever became unsuccessful by helping others out

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            • hlh
              hlh commented
              Editing a comment
              We recently tried putting a foam dressing on it, but find that it doesn't stay on very well. It is very hard to "tape" it, as tape doesn't stick well to the foam. And the area we are taping it to is irregularly shaped the dressings are often a little too stiff or too thick and don't contour well. The sore is at the intersection of the posterior thigh, low butt cheek and scrotum.

            #21
            He should retry Enemeez but use Enemeez plus (or docusol plus) which has Benzocaine 20 mg in it. It will numb the pain some. Hemorrhoids are due to pushing or maybe dig stim/evacuation. Enemeez does not cause chemical irritation inorder to have movement. Bisacodyl does. He has to make sure the enemeez comes in contact with the rectal mucosa. But he most likely has a sphincter that won't relax. hard to tell. Surprised with all those opioids and meds he isn't more constipated. Is stool is formed but not hard, no lumps? Consistency of the stool is very important to look at. Sometimes just a stool softener is needed.

            Right side is fine to do bowel program on. Rojos have to be pressure mapped for the individual. How can you not cover it if it is open and stool is getting n it? Even if just covered temporarily for bowel program.
            For foam dressing you have to use the one that has the water proof membrane over it or as a windowpane. Put opsite or its equivalent (transparent kind of like saran wrap but sticks better) over the foam dressing. At least an inch on each side.

            CWO
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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              #22
              Originally posted by SCI-Nurse View Post
              He should retry Enemeez but use Enemeez plus (or docusol plus) which has Benzocaine 20 mg in it. It will numb the pain some. Hemorrhoids are due to pushing or maybe dig stim/evacuation. Enemeez does not cause chemical irritation inorder to have movement. Bisacodyl does. He has to make sure the enemeez comes in contact with the rectal mucosa. But he most likely has a sphincter that won't relax. hard to tell. Surprised with all those opioids and meds he isn't more constipated. Is stool is formed but not hard, no lumps? Consistency of the stool is very important to look at. Sometimes just a stool softener is needed.

              Right side is fine to do bowel program on. Rojos have to be pressure mapped for the individual. How can you not cover it if it is open and stool is getting n it? Even if just covered temporarily for bowel program.
              For foam dressing you have to use the one that has the water proof membrane over it or as a windowpane. Put opsite or its equivalent (transparent kind of like saran wrap but sticks better) over the foam dressing. At least an inch on each side.

              CWO

              I really appreciate your ideas. Thanks.

              Fortunately, his bowels are moving very well. He has tried Enemeez and Enemeez plus several times and they just don't work for him. But you are right, that it is always a good idea to go back and retry things because sometimes things change over time.

              Yes, he is very fortunate that opioids do not slow down his bowels. His stool is well formed, very normal caliber/shape. He is followed by a GI doctor with an interest in neurogenic bowel. He is currently on a lot of bowel meds, but they seem to help - Linzess, misoprostol, miralax (titrates as needed), probiotic.

              We are now using an excellent dressing that we originally only put over the wound during his bowel program. But it actually covers this (awkward) area so well that he is able to tolerate it all day. It is Optifoam gentle silicone boarded foam. It secures to the skin without adhesive and comes of easily without damaging and is flexible/soft enough it can lie over this sensitive area without causing problems. How I wish we knew about this months ago.

              I have also added some home-made re-design to his toilet set up to elevate the front of his ROHO (commode style) so that he bottoms out less and the sore is floating when he is on the toilet. It is looking much better and healing. Currently, he is using A & D cream with zinc on the small open wound, which is drying up and we are trying regular A & D cream for his red/irritated/shearing sensitive skin adjacent to the open wound (this area is much larger). But his skin dries out even when I use a lot of the creams if I leave it covered for 24 hours. May need to change to every 12 hours dressing change. The nurse wants to change to Medihoney as soon as we can get it.

              We are ordereding a custom ROHO for the toilet that is taller, and should help avoid the bottoming out that caused his most recent sore.

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                #23
                Sounds promising. Medihoney can work well. Foam sounds like what he needs. CWO
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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