Digital Removal of Faeces (DRF)

Digital removal of faeces refers to the use of a gloved lubricated finger, gently inserted into the rectum to remove the stool. This ensures that the lower bowel is empty of faeces, providing some assurance that the person can go about their daily activities with confidence that they will not have an unplanned bowel movement. We recommend that this method of bowel management is attended twice a day to prevent the potential for unplanned bowel movements in the evenings, as faeces can “move down” the intestine throughout the day.

The removal of stool from the rectum prevents over distension and consequent damage to the lower bowel. This method of management is identified as an option for individuals with Lower Motor Neurone (LMN) or Cauda Equina Syndrome (CES) Neurogenic Bowel Dysfunction. This assists with emptying of the lower bowel to prevent unplanned bowel movements secondary to atonic rectal sphincters. It may also be used to complete a bowel routine where Upper Motor Neurone (UMN) ‘reflex’ activity is insufficient to complete bowel elimination.

(Fenton J. (2019) Bowel Care: Management of lower bowel dysfunction including digital rectal examination and digital removal of faeces. Royal College of Nursing) 

Procedure

1. Gather the required equipment
   • Non-sterile gloves
   • Apron
   • Water-based lubricant
   • Protective pad (Bluey) if required
   • Soap and water / wipes (for in bed)
   • Plastic bag/bin available (for rubbish disposal)
2. Ensure the individual’s dignity and privacy always is maintained.
3. Introduce yourself to the person. Check person identification. Explain the procedure and obtain verbal consent. Demonstrate understanding of the need to stop immediately if individual requests.

4a. If unstable injury

• Procedure needs to take place during formal “log roll” procedure.
• Ensure position of person such that spinal alignment is always maintained.

4b. If stable SCI

• Procedure can take place in bed
• Place person in left lateral position (if possible), flexing the knees to promote stability and expose the anus

4c. If procedure taking place in shower commode

• Position for comfort and anal access 

5. Place protective pad, if required on the bed or floor of bathroom.
6. Don plastic apron, wash hands and put on a pair of non-sterile gloves
7. Observes individual throughout procedure (especially those at risk of Autonomic Dysreflexia (AD))
8. If known to suffer discomfort or signs/symptoms of AD- local anesthetic gel may be instilled into rectum 10 minutes prior to procedure
9. Generously lubricate index finger with water-based lubricant
10. Inform person when beginning and inserts single lubricated gloved finger slowly and gently into rectum (digital check for faeces) and slowly rotates finger
11. If stool is solid mass – push finger into center, split it and remove small sections until none remain
12. If stool is in small hard lumps- remove each lump one at a time
13. Care should be taken to avoid damage to the rectal mucosa and overstretching the external anal sphincters by gently sliding faeces from the rectum with a straight finger
14. If stool is soft- gentle circling of the finger may be used to remove faeces, continue process until all faeces removed from lower bowel
15. Dispose of faecal matter in appropriate receptacle. Removes gloves and apron discard accordingly and performs hand hygiene
16. Apply non-sterile gloves to clean and dry person’s buttocks and anal area
17. Reposition person, if required
18. Perform hand hygiene
19. Record outcome such as amount and consistency as per the Bristol Stool Scale 
20. Report any abnormalities to person, team leader or medical officer and documents accordingly