Equipment and assistive technology
Adaptive devices
People with spinal cord injury (SCI) who have functional impairment of the upper limbs may find it difficult to manage tasks required for bowel care (e.g. inserting enemas or suppositories).
Adaptive devices listed below may help a person with an SCI to achieve greater independence with inserting enemas or suppositories during bowel care.
Suppository inserters are commercially available devices with modified handpieces that allow a person with reduced hand function to self-insert their suppository.
Suppository insertion is done while the person is lying in bed, as this allows time for the suppository to ‘melt’ and take effect.
To use the device, the person puts their hand through the modified handpiece then puts the suppository inside the hollow plastic tube.
The person then reaches around, locates the anus and inserts the suppository.
The device has a spring on the stem and, when light pressure is applied, the suppository is pushed out.
It is important to pay attention to the length of time between the insertion of the suppository and the subsequent bowel movement, to ensure adequate time for a safe and unhurried transfer to the toilet or commode.
Enema inserters are not commercially available but can be manufactured.
Enema inserters, like suppository inserters, use a modified handpiece.
Due to their design, enema inserters require a reasonable amount of pressure to squeeze and empty the fluid.
To use the device, the person puts the enema into the holder, then places a cap over the top of the enema.
A rubber band prevents the cap from falling off and helps the cap to slide up and down when the enema is inserted, allowing the fluid to be squeezed out.
A therapist and/or nurse can conduct an assessment to review the positioning required and the process for performing independent bowel care.
Therapist considerations for the assessment/use of an enema inserter
- What type of product (suppository or enema) is the person using?
- Can the person access the product?
- Can they pick it up?
- Can they peel open the packaging or access doses that have already been removed from the wrapper? Some people can tear the packaging open by using their teeth. Be mindful that the suppositories may soften in warm environments, if they have already been unwrapped for a period of time.
- Can they remove the tip/cover from the enema? If it is pre-opened, the fluid could spill from the enema. Storage once open is important.
- What is the person’s balance, positioning and reach like?
- Is the reach better on bed or on the mobile shower commode? If the person is using a commode, the preferred product to use would be an enema, as suppositories need time to melt to be effective and could also be expelled intact, in a sitting position.
- Will the person need to use mirrors to help with the task? Can this be set-up independently? Would a wall or door mounted mirror make the task easier instead of a smaller standing mirror placed on the bed?
- Is the bed/mattress a suitable surface (or combination) to allow the task to be completed?
- Check firmness of the mattress and independence with bed mobility.
- Does the bed size allow enough space to move and complete the task?
- Is it possible to adjust the angle of these devices to cater for the person’s hand function and position?
- Does the strap or mechanism of holding the suppository or enema need adapting, due to the degree of hand function impairment?
- Does the person have access to any care supports for assistance, if needed? This could allow for the ability to attend to preparation for the routine, assist with some of the associated tasks or allow supervision or support until the person can master the task independently.
You can contact a QSCIS occupational therapist for more information and support as needed.