Manual Evacuation of Faeces
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.
Discussion
Solomons and 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.
Authors; Country
Date included in the review Total Sample Size Types of Articles Score |
Methods
Databases Level of Evidence |
Conclusions |
Solomons & Woodward 2013;
Britain Systematically reviewed articles from electronic databases no date limits applied N=7 Type of study: 1 RCT 4 case-controls 1 cross-sectional 1 case-control AMSTAR: 2 |
Method: Systematic literature review of the quality of evidence available on fecal manual evacuation for individuals with SCI.
Databases: CINAHL, British Nursing index, EMBASE, Medline Level of evidence: Methodological quality not assessed |
|
Author Year; Country Score Research Design Total Sample Size |
Methods | Outcome |
Coggrave et al. 2009;
UK Pre-post N=1334 |
Population: 1334 SCI outpatients aged 19-91 yrs.
Treatment: Postal survey Outcome measures: method of evacuation; number of interventions used before finding a successful protocol; assistance with bowel care. |
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Correa & Rotter 2000;
Chile Pre-post N=38 |
Population: Age: range 19-71 yrs; 21 participants with complete injuries (2 with tetraplegia and 19 with paraplegia), 10 with incomplete injuries, 7 with conus medullaris and cauda equina; Duration of injury: range 5 months -16 yrs.
Treatment: Intestinal program administration with 6-month follow-up. The program involved monthly evaluations of the patient’s intestinal function, symptoms and complications. Patients were educated on inadequate practices of evacuation and medications were changed when appropriate. Manual evacuation was discouraged as high-risk. Outcome Measures: Difficult Intestinal Evacuation (DIE) scale; colonic transit time; anorectal manometry; recto-colonoscopy; GI symptoms. |
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Haas et al. 2005;
Switzerland Cross-sectional N=837 |
Population: 837 SCI patients (642M, 186F) from 29 rehabilitation facilities in Austria, Germany, the Netherlands and Switzerland. Injury level: 42% cervical, 45.3% thoracic, 12.7% lumbar.
Treatment: questionnaire Outcome measures: method of evacuation, rate of incontinence, rate of bowel symptoms |
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Menter et al. 1997;
UK Retrospective longitudinal N=221 |
Population: 221 SCI patients; 29% tetraplegia (ASIA A/B/C), 49% had paraplegia (ASIA A/B/C) and the remaining 21% were classified as having incomplete, ASIA D paraplegia or tetraplegia.
Treatment: questionnaire, physical examination, physiological measurements. Outcome measures: medical records, bowel management techniques. |
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