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Manual Evacuation of Faeces

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Manual evacuation of faeces involves the use of a single gloved and lubricated finger to remove faeces from the rectum. It is used by individuals with both hyperreflexic and areflexic bowel dysfunction. Coggrave et al. (2009) (n=1334) reported that manual evacuation of faeces for people with SCI was found to be the most commonly used intervention, carried out by 56% of respondents. A systematic review (Solomons & Woodward 2013) found that digital stimulation and digital removal of faeces were associated with the lowest rates of unplanned bowel evacuations and less time spent on bowel care (Haas et al. 2005) and concluded that digital removal of faeces is a necessary component of bowel care for many individuals with SCI.

Table 6: Manual Evacuation of Faeces Systematic Review

Table 7: Studies on Manual Evacuation of Faeces

Discussion

Solomons & Woodward (2013) reviewed 7 articles which used manual evacuation as part of a bowel management protocol. They found that manual evacuation was very commonly used in individuals with SCI (Menter et al. 1997; Coggrave et al. 2006; Coggrave et al. 2009), and was effective in reducing the number of unplanned bowel evacuations (Haas et al. 2005), but had a high self-reported rate of constipation (Menter et al. 1997). Conversely, Haas et al. (2005) reported a decrease in bowel evacuation time with manual evacuation. It is worth noting that the GP diagnosis of constipation in Menter et al. (1997) was significantly lower than the self-reported rate of constipation.

Conclusion

Manual evacuation is a key method in conservative bowel management practice and is commonly and widely employed. It reduces number of unplanned bowel evacuations. There is conflicting evidence on the effect of manual evacuation on duration of bowel evacuation.

  • Digital evacuation of stool is a very common intervention for bowel management after SCI, reducing duration of bowel management and fecal incontinence.