Manual Evacuation of Faeces

Manual evacuation of feces involves the use of a single gloved and lubricated finger to remove feces 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 feces 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 feces were associated with the lowest rates of unplanned bowel evacuations and less time spent on bowel care and (Haas et al. 2005) concluded that digital removal of feces is a necessary component of bowel care for many people with SCI.

Discussion

Although there are few intervention studies, there are reports of people using manual evacuation for bowel management alongside other methods. Solomons & Woodward (2013) reviewed 7 articles which used manual evacuation as part of a bowel management protocol. They found that manual evacuation was commonly used in individuals with SCI (Coggrave et al. 2006b; Coggrave et al. 2009) and was effective in reducing the number of unplanned bowel evacuations with digital rectal stimulation (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.

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, though some research shows that it decreases bowel management time.