Multi-Faceted Bowel Management Program

Michelle R, the nurse doing Mr. RB’s bowel care, describes that Mr. RB has large round hard stools in his rectum when bowel care is performed. This “bowel routine “consists of milk of magnesia given 12 hours before a planned digital stimulation. He is also disimpacted following digital stimulation, if required. He takes docusate sodium twice a day and a fibre supplement once a day and 2L of water per day. In addition, she finds that moderate sized round hard stools can be routinely found in the rectum even on days when he is not having a bowel routine.

Joanne K is the charge nurse on this spinal cord rehabilitation unit, and helps Michelle R design a multi-faceted bowel management program for this patient. Joanne K teaches Michelle R how to trial various positions and maneuvers with the patients in order to find the best one for them.

Q8. What are the various components that make up a multi-faceted bowel management program?
The various components of a multi-faceted bowel management program include:
1. Appropriate fluids, diet, and activity.
2. Appropriate rectal stimulant and rectal stimulation initially to triggerdefecationdaily.
3. Optimal scheduling and positioning.
4. Appropriate assistive techniques.
5. Evaluation of medications that promote or inhibitbowel function.
6. Consistent schedule for defecation establishedbased on factors that influence elimination, pre-injury patterns of elimination, and anticipated lifedemands.
7. Mechanical and/or chemical rectal stimulationto evacuate stool.
8. Use of individualized assistive techniques, push-ups, abdominal massage, Valsalva maneuver, deep breathing, ingestion ofwarm fluids, and a seated or forward-leaning positionto aid in bowelemptying.
Q9. What is the evidence for a multi-faceted bowel management program?
1. There is level 4 evidence that a multifaceted bowel management program reduces gastrointestinal transit time, incidences of difficult evacuations, and duration of time required for bowel management.
2. There is limited evidence supporting a multifaceted program for managing a neurogenic bowel although it remains established practice.
For more information, please see: Multi-Faceted Bowel Management Program.