Bowel management plan
A bowel management plan is decided based on the type and location of a spinal cord injury. The goal of a bowel management plan is to provide predictable and effective elimination and reduce gastrointestinal and evacuation complaints.
Effective treatment of common neurogenic bowel complications, including faecal impaction, constipation, and haemorrhoids, is necessary to minimise potential long-term morbidities. Bowel management starts during acute care and is revised as needed.
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. When reintroducing fluids, start with small amounts of clear fluids (preferably using a spigot, inserted into an 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 medication 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 an 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 performing digital rectal stimulation, to encourage the defecation reflex and relaxing of the anal sphincter.
- Request that the person has a hot drink or breakfast 20-30 minutes prior to the bowel routine, if possible.
Bowel management: lower motor neurone
This method of management commences immediately after diagnosis of spinal shock, LMN or cauda equina syndrome (CES):
- Aperients: Bulking agents can be used if required. Further consultation with QSCIS on aperients if constipation identified.
- Triggers Digital removal of faeces.
- Provide education on self management as soon as able.
- Flaccid paralysis eg. low tone of detrusor, bladder or bowel sphincters, skeletal muscles.
Downloads
This template provides an opportunity to document the person’s bowel movements and diet for the week. Download a copy and fill out the fields weekly to get a better idea of the person’s bowel management.
Audience: Person with SCI