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.
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.
2. There is limited evidence supporting a multifaceted program for managing a neurogenic bowel although it remains established practice.