Bowel management plan

Bowel management: spinal shock

• Prescribe a proton pump inhibitor medication. This is required due to low pH and risk of stress ulceration.
• Regularly check for bowel sounds indicating resolution of associated paralytic ileus.
• Use a naso-gastric tube (NGT) to assist with draining gastric contents whilst the ileus is present.
• Consider regular measurement of girth to monitor for ileus.
• Provide intravenous hydration until bowel sounds return.
• Commence enteral/oral nutrition only when bowel sounds return.Start with small amounts of clear fluids (preferably with spigotted NGT and 4/24 aspirates) and then graduate to a full diet as tolerated.
• Assess ongoing bowel sounds until bowel sounds are very active and/or stools are being passed.
• Commence rectal medicaton of bisacodyl suppositories if on bed rest. Attend to daily digital removal of faeces (DRF) from the rectum if present, this should be performed gently and using ample lubrication.
• Use oral aperients once bowel sounds have returned and oral intake is tolerated.
• Perform anorectal exam daily during spinal shock in UMN injuries to establish emergence from spinal shock. A positive BCR* on the anorectal exam will signify this.

Bowel management: upper motor neurone

• Use oral aperients consisting of 100-120mg Coloxyl BD and 15mg Senokot nocte.
• If on bed rest, use 1-2 Bisacodyl suppositories mane and digital rectal stimulation.
• When mobile in a shower commode, consider using enemas and doing digital rectal stimulation for Defaecation Reflex and relaxing of the anal sphincter.
• Request person to have a hot drink or breakfast 20-30 minutes prior to the bowel routine if possible.

Bowel management: lower motor neurone

This method of management immediately commences after diagnosis of LMN or Cauda Equina Syndrome (CES)

• Use oral aperients 15mg sennokot nocte, consider use of firming agent if required. See Right Consistency for more information.
• Commence daily or BD routine of doing a digital check and subsequent digital removal of faeces as required. This can be managed in bed or over the toilet pending mobility. See Right Trigger for more information.
• Provide education on self management as soon as able.
• Flaccid paralysis eg. low tone of detrusor, bladder or bowel sphincterss, skeletal muscles.

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