Digital stimulation

Digital stimulation works by triggering reflexive activity in the Upper Motor Neurone (UMN) bowel to initiate contractile actions in the rectum. Promoting relaxation of the bowel sphincter further assists in bowel emptying.

Procedure

• 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)
• Ensure the individual’s dignity and privacy always is maintained.
• 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.



If unstable injury

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

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

If procedure taking place in shower commode

• Position for comfort and anal access 
• Places protective pad, if required on the bed or floor of bathroom. Enemas can be given over the toilet if there is adequate access.
• Don plastic apron, wash hands and put on a pair of non-sterile gloves. 
• Observes individual throughout procedure, especially those at risk of Autonomic Dysreflexia

If known to suffer discomfort or signs/symptoms of AD

Local anesthetic gel may be instilled into rectum 10 minutes prior to procedure.

• Generously lubricate index finger with water-based lubricant.
• Inform person when beginning and insert single lubricated gloved finger slowly and gently into rectum 2-4cm (up to second knuckle on finger). This relaxes both the internal and external sphincters.
• Gently rotate the straight finger in a circular motion against the rectal wall for approximately 10-20 seconds. 
• When you feel the faeces starting to move apply gentle stretch to the external anal sphincter to enable passage of faeces.
• Care should be taken to avoid damage to the rectal mucosa and overstretching of the internal and external anal sphincters.
• If no stool present withdraw finger and await “reflex evacuation”. Await 5-10 minutes between stimulation and perform no more than 3 times. 
• The presence of mucous (clear, jelly like substance) from the lower bowel may be an indicator that the lower bowel is empty – ongoing stimulation isn’t recommended. 
• If the rectal vault feels bulbous (like a blown-up balloon) this could indicate the stool is higher in the bowel and recurrent stimulation is not recommended – consider dietary and pharmaceutical methods to transit the stool lower in the bowel. 
• Dispose faecal matter in appropriate receptacle.
• Removes gloves and apron, discard accordingly and performs hand hygiene. 
• Apply non-sterile gloves to clean and dry person’s buttocks and anal area.
• Reposition person, if required
• Perform hand hygiene. 
• Record outcome such as amount and consistency as per the Bristol Stool Scale.  
• Report any abnormalities to person, team leader or medical officer and documents accordingly.   
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Cautions to digital stimulation
• If bleeding or pain is experienced during or after this procedure, please seek medical advice.
• Autonomic Dysreflexia may be triggered by this procedure. Information on Autonomic Dysreflexia. 
• Monitor for symptoms and cease stimulation immediately.

As the Defaecation Reflex Centre is ineffective for people with LMN bowel types, there is little point in trying to “stimulate” this reflex with the use of enemas, suppositories or digital stimulation (although enemas may provide some level of lubrication to assist in bowel emptying). 

The recommended method of evacuating faeces from the rectum for people with LMN bowels is Digital Removal of Faeces (DRF) (previously referred to as Manual Evacuation).