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thoughts on a different bowel program

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    thoughts on a different bowel program

    Thanks for letting me ask about some challenges I have with my bowel program.

    I apologize for my wording, but I needed to use Google translate to express myself accurately on english

    I live in a home for the physically handicapped and need help with any physical task, including going to the toilet. I can not sit on the toilet, so I lie on a couch in the bathroom, when my caregivers doing my bowel program.
    I'm sorry if I'm too direct, but I've read some other topics in here, so I think I can ask about this.

    For daily I use Peristeen anal plugs, from morning until I go to bed. They work really well for me. I have only very few accidents.
    My regular caregives on site perform my bowel program.

    Now they have changed my bowel program after the hospital I am affiliated with has changed their guidelines regarding my bowel program. so I have been hospitalized for a few days, to get my bowel program adjusted. My caregivers are really caring and careful as always, the hospital said my body can respond more to the increased stimulation.
    Over the last six months, my bowel program has taken longer and longer and is harder to get completed. I do not know what I think about it.

    Since I was discharged from the hospital ten years ago, I have been using the suppository for half an hour before my caregivers use digital stimulation for about half a minute up to three times. At the same time they give me abdominal massage which also has a good effect.

    After giving one or two suppositories and waiting for it to work. I have no verbal language due to my respirator controlling my breathing, so my caregivers do a rectal check every five minutes to assess if I am ready for digital stimulation. Then they start with digital stimulation.
    Now they need to insert the finger 2 to 2.5 inches and moving in circular motions about three minutes at the rate of approximately one second per turn. Ar the same time my other caregiver is doing stomach massage
    i feel like it's a long time, sorry my language, they need to have a finger my anus, but that's what my caregivers were instructed in.

    At the same time they have been instructed during or between doing digital stimulation, to do perianal massage / support, to relax my sphincters. They press two fingers on the area between the anus and scrotum in the direction of the anus, and continue pushing in pulses of 3 to 5 seconds each.

    They have said that I and my caregivers should try the new method, for two months, to assess whether it is better and whether it helps me.

    Usually I am determined and persistent when the hospital suggests new ways to help me with different things, and although it is not too uncomfortable, it is a special feeling to have to be stimulated in the three places at the same time.

    I'm going to continue and do as the hospital suggests some time, but I'm really in doubt about their suggestion to do so.

    I need to hear from you what you think about it? I do not want to spend so much time on my bowel program, so I really want to give it a try. I hope you will share your thoughts on it

    Thanks for letting me into the community.


    Nikolaj--Sorry to see that you haven't received any responses to help you out. I don't know where you're located but if you can get "Magic Bullet" suppositories or "Enemeez" you might want to try those. Best wishes.


      I wish I had some advice but I know nothing about Caregiver performed BP and how to optimize it. I'm a T12 who's been doing self care for ~15 years and I have the same issue with time, though. I use Magic Bullets and they still take ~45-60 minutes to kick off and another couple hours to finish and clean up. It's a 3 hour ordeal every other day no matter what, I fear. Peristeen system is lauded by many as a game changer, so are colostomies. Maybe worth considering.
      "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


        What is your level of injury?
        it sounds like you are using suppositories but the bowel program is lengthy with digital stimulation and abdominal massage
        you are using a persistent plug for incontinence - how often were you having accidents?

        i would also inquire as to your diet in terms of water and fiber intake?
        how do you manage your bladder? History of urinary tract infections?

        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.


          Thank you for your reply :-)
          i can not get a colostomy as i have to avoid having surgery as much as possible.
          My back was made stiff after the injury, which sits both at the bottom of the neck c3 and in the lumbar l2. I was unlucky to get two breaks, after a very unfortunate fall in the bathroom.
          Both of them are incomplete. I do not know how, but the doctors found, so a few places I still have senses, including my buttocks, anus and the perianal area. But not in my bladder, so I have an indwelling catheter. Very rarely urinary tract infections.
          If I do not use anal plug every day, I have bowel accidents two to four times a week.
          I get fluid and tube food through the point probe.

          My caregivers and I have now been following the new method for two weeks. They are now two about my bowel movement every morning.
          The caregiver who does the digital stimulation says that it takes about two minutes before my sphincter starts to try to relax. Then my caregiver continues one more minute, which they were told and taught to do.
          But now they are starting to feel that the sphincter muscles relax more when they do perianal massage at the same time. It requires them to apply a certain long pressure in the direction of the anus. And they do that both when they do digital stimulation and in the meantime where I have bowel movement.
          Sometimes they also keep the pressure on the perianal area for a long time at a time, to make sure that the sphincter muscles continue to relax. It was a trick given by one of the nurses when they started the new method.
          Both my caregivers and I think it's really a lot that my body needs to be stimulated and I'm just starting out in the new way.
          My caregivers have told the hospital that we are continuing, but that I find it degrading. It is only because we begin to see an effect that we continue.
          Is it okay to offer a young man such a treatment? My caregivers can also see that my body reacts differently in the lower regions. Things that one can expect can happen when one is stimulated in the rectum, perianal massage and abdominal massage at the same time. At the hospital, they told me that such things could happen, depending on how sensitive one was. But I had to try to see if I would be able to live with it.


            I can't quite figure some of this out. Not sure what they are looking for to see if ready for dig stim. If bowel program is good you should not be having accidents in between.
            the way to do dig stim is to make sure no stool in rectal vault. finger has to be able to feel the mucosa of the rectum.As they slowly go around they should feel it loosen then contract, then loosen. It should be done no longer than 30 minutes or after movement from suppository or enemeez. then every 15 minutes. To spread it out longer just is not good. you have to use the momentum. It is kind of like traffic on a freeway. when it starts moving, you don't want to wait longer in between.
            Is is stool or mucous that comes out after use of 1-2 suppositories? This mucous is caused by the the suppository that acts as a chemical irritant and can actually cause mucosal injury. I have had to change patients even though the suppository worked due to this excess mucous which made them have to wear a diaper. We change to changed to Enemeez/Enemeez Plus which is generically -docusate 283 mg rectally and is a normal is not a chemical irritant and is a hyperosmolar agent. (draws water in to the rectum).
            Your description indicates the nurses seem to recognize the sphincter contraction or kow that is what they are feeling for.

            Enemeez and Enemeez PLus (with benzocaine- an anesthetic/numbing agent) is readily available in US, Canada and United Arab Emirates. However, would like to make it available to all.

            Have your nursing staff look up the Bristol Stool Scale - or do they already use? I do not recommend anal plugs and we very seldom use. If stool stays in the rectum, it can back up and it will dry out. It can cause more problems. Stool should be a Type 4- formed but not too soft and no hard lumps.
            Are you a complete cervical injury or partial? Lumbar? very difficult to tell what type of bowel you have but sounds like the cervical is running this show due to hyper anal sphincter but why all the accidents?
            If your facility is interested in looking at enemeez have them send a private message to me and I will have the company contact them, or give them contact information.
            What country?


            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.