Right trigger

The consistency of the stool will depend on how much water is reabsorbed while passing through the large bowel. The shorter the transit time, the less water is reabsorbed from the faeces, resulting in a softer stool.

Very soft or ‘sticky’ stools (best described as toothpaste or peanut butter) are difficult for muscles along the digestive tract to push through effectively and can be hard to completely empty from the rectum. The pooling of soft stools within the bowel can also lead to constipation over time.

The right trigger is about using the correct methods to get the stool (which needs to be in the ‘Right place at the Right time’ to effectively empty from the rectum). When deciding between use of an enema or a suppository to trigger defaecation, consider the following factors

• Level of injury and functional ability – suppositories are often wrapped in foil or plastic and can be difficult to access or insert if there is impaired hand function and strength, although aids can be utilised to assist with insertion of same: Enemas or suppositories. Stimulation provided during the insertion process adds to the defaecation reflex.
• Time available to be spent on the routine – suppositories are “bullet – shaped” wax impregnated with medication. There is a waiting period for the wax to heat and melt before the medication can be released and absorbed by the bowel. This absorbed medication then “irritates” the bowel wall, stimulating the defaecation reflex. This process can take anywhere between 20- 45 minutes, and is best attended whilst in bed, only sitting over the toilet towards the end of the routine when the bowel motion is expected. Alternatively, enemas can be inserted whilst seated over the toilet, and may take anywhere between 5-20 minutes to work.
• Personal preference – one method may work better than another and often comes down to personal preference. Most medications used to assist bowel emptying come in either enema or suppository form, although more commonly used enemas (Microlax/Micolette) are mild, and do not contain medication to irritate the bowel. People requiring medicinal irritation often use suppositories (eg Dulcolax, Bisacodyl) or the enema form (Bisalax).
• Care agency considerations – some care agencies will have restrictions over who can or cannot administer certain types of medication.
• Additional stimulation- Inserting an enema has the advantage of providing additional rectal stimulation through a gentle stimulation and stretch when removing the enema.

Methods to trigger stool