Other triggers

While enemas, suppositories and digital techniques are highly effective, there are various ways to help trigger defecation.

Trans-anal irrigation (TAI)

Trans-anal irrigation is a procedure where body-temperature water is passed into the rectum to help move the stool from the lower end of the bowel and aid evacuation.

There are a variety of irrigation systems available, many of which require prior training, so it is important to seek advice from a health professional before use.

Gastro–colic response

Gastro–colic response is an increase in muscular contractions (peristalsis) in the bowel, generated by filling the stomach with either food or warm fluids (usually strongest in the morning, 20-30 minutes after eating).

Activity and exercise

Activity and exercise can stimulate peristalsis – another incentive to keep the person as active as possible. Exercise can help to manage pain and decrease the need for pain medication, many of which are known to cause constipation.

Optimal positioning

An optimal anorectal angle for emptying the rectum is to place the knees higher than the hips and elbows, supported on the knees by bending forward in the ‘thinker’s position’. This may be easier to achieve in someone who has good sitting balance. Skin also needs to be monitored, as this position can cause shear or friction wounds over points of contact with the shower commode or toilet seat.

Straining

Often a lower motor neurone (LMN) injury means the abdominal muscles are working and this can help with bowel emptying. However, caution should be taken with excessive straining, as there may be nerve damage to the pelvic floor. The pelvic floor supports the internal organs, and straining may increase the risk of haemorrhoids, vaginal and/or rectal prolapse. Breathing exercises and correct positioning on the toilet (see ‘Optimal positioning’ above) may help to improve emptying without straining.