Bowel Care Techniques

Treatments for bowel relief

Digital stimulation, or dil, is a way to empty the reflex bowel after a spinal cord injury. It involves moving the finger or dil stick around in a circular motion inside the rectum. By doing this, the bowel reflex is stimulated and the rectal muscles open and allow the stool to leave the body.

This procedure is best done on people who do not have painful sensation in the rectal area. Pressure may be felt in the rectal area, but it should not be painful. The dil should be done at the same time every day or every other day to stay on a schedule and avoid bowel accidents. The time and frequency depend on the individual.

How to do digital stimulation

  • Gather supplies:
    • Gloves
    • Dil stick, if ordered
    • Lubricant
    • Soap, water, washcloth
    • Toilet paper and under-pads, if done in bed
    • Plastic bag to throw away waste
    • Raised toilet seat, commode chair or shower chair if done in the bathroom
  • Wash hands.
  • Prepare all needed supplies and place on a towel.
  • Position yourself.
    • If doing the dil in bed, lie on the left side with knees flexed, with right leg over left leg, and place disposable pad under the buttocks.
    • If doing the dil in the bathroom, transfer to appropriate bowel equipment such as a raised seat or ActiveAid.
  • Perform the dil.
    • Put gloves on both hands or place dil stick in the hand.
    • Lubricate pointing finger or dil stick, whichever will be entering the rectum.
    • Gently put finger or dil stick into the rectum past the muscle.
    • Gently move the finger or dil stick around in a circular motion.
    • When the stool begins to empty from the rectum, move the finger or dil stick to one side or remove so the stool can pass.
    • Do this for at least 20 minutes if no stool is coming. If stool is produced, do the dil as long as the stool is coming dil and for five additional minutes afterward without getting any more stool.
    • You may need to gently remove stool from your rectum with your finger if it does not come out on its own.
  • Finish up.
    • When finished with the dil, wipe rectal area and buttocks with toilet paper, wash with soap and water, and dry with a towel.
    • Clean dil stick with soap and water, and dry well.
    • Throw out waste and wash hands.

Advisory for spinal cord injury patients

The dil may cause dysreflexia in persons with spinal cord injuries at T6 and above. Always observe for autonomic dysreflexia symptoms, including increased blood pressure, headache, blotchy skin, sweating, and stuffy nose.

If the person experiences autonomic dysreflexia during the dil:

  • Stop the dil.
  • Sit up if not already doing so. Sit up in the bed or in the chair, depending on the location.
  • Insert a local numbing agent like Nupercainal ointment into the rectum.

If dysreflexia goes away, continue the bowel program as planned. If dysreflexia continues or gets worse, then proceed with the treatment plan described in the autonomic dysreflexia section.

The two-piece ostomy flange is commonly used with people who have either an ileostomy or a colostomy.

There are two parts: the flange and the pouch. When changing the pouch, observe the color, size, and odor of the drainage. Observe for any skin irritation. Inform your primary care physician of any changes.

How to change a two-piece ostomy flange

The flange should be changed every 5 to 7 days. The pouch should be emptied when no more than 1/3 to 1/2 full. The best time to change your flange is in the morning when your bowels are less active.

To attach the pouch:

  • Gather supplies:
    • Snap-on pouch
    • Flange
    • Sealant (example: Sureprep)
    • Paper towels, tissue or wash cloths, and wet and dry towels
    • Plastic garbage bag
  • Prepare flange by cutting opening to fit stoma, using pattern provided or stoma guide in the box, and adding a very small space (1/16th of an inch) around the stoma.
  • Remove flange.
  • Clean skin with water and dry thoroughly.
  • Cover the stoma with a paper towel or tissue to prevent accidents.
  • Apply sealant such as Sureprep.
  • Apply flange to skin around the stoma.
  • Snap pouch on and test seal.
  • Wash hands.

To empty the pouch:

  • Empty when no more than one-third to one-half full.
  • Remove pouch from flange.
  • Snap new pouch back on flange.
  • Rinse out old pouch or soak in soapy water.
  • Alternatively, empty pouch from the bottom.
  • Wash hands.

To burp the pouch when it fills with gas:

  • Lift pouch slightly off flange, then snap back on.
  • Check seal.
  • Wash hands.

Manual evacuation, also known as rectal clear, is used for people with a non-reflex bowel. Stool is emptied by gently inserting a finger into the rectum and removing it. This procedure is usually done every day or every other day. The time and frequency will depend on the individual’s needs.

How to do a manual evacuation

  • Gather supplies:
    • Gloves
    • Plastic bag to throw waste in
    • Soap and water
    • Washcloth and towel
    • Toilet paper
    • Lubricant
    • Under-pads if done in bed
    • Raised toilet seat, commode chair, shower chair
  • Wash hands.
  • Prepare all needed supplies and place on a towel.
  • Position yourself.
    • This may be done in the bathroom on a seating device.
    • If done in bed, lie on left side and place an under-pad under the buttocks area. You may find it helpful to prop up on your elbow or place padding up under your left side.
  • Put gloves on both hands.
  • Place lubricant on your finger.
  • Insert finger into rectum and check for stool.
  • Using a scooping motion, gently remove any stool present in the rectum.
  • Repeat the process until no stool remains, changing gloves and re-lubricating finger as needed.
  • When no more stool comes out, clean buttocks and rectal area with toilet paper and then soap and water, and dry well.
  • Flush toilet or throw out waste.
  • Wash hands.

Rectal suppositories are used for people with a non-reflex bowel or for people who still have feeling in the rectal area and cannot tolerate digital stimulation (dil). Sometimes they are even used with a dil.

They should be given at the same time every day or every other day in order to stay on schedule and avoid bowel accidents. Suppositories are generally used at night because they can take anywhere from 15 minutes to 8 hours to work.

Common suppository brands include Dulcolax, Therevac, and Magic Bullet.

How to insert a rectal suppository

  • Gather supplies:
    • Gloves
    • Lubricant
    • Suppository
    • Plastic bag to remove waste
    • Soap, water, washcloth, and towel
    • Toilet paper
    • Underpads (if doing this in the bed)
    • Raised toilet seat, commode chair or shower chair (if doing this in the bathroom)
  • Wash hands.
  • Prepare all needed supplies and place on a towel.
  • Lie on left side and place an underpad under the buttocks area.
  • Put gloves on both hands
  • Place lubricant on your finger and do a rectal clearing 30 minutes before putting in the suppository.
  • Place small amount of lubricant on the tip of the suppository.
  • Put suppository into the rectum. Do not push suppository into stool.
  • Leave the suppository in place for at least 30 minutes.
  • If able, transfer to a commode chair, raised toilet seat or ActiveAid.
  • If not able to transfer, stay on left side and do a rectal clearing onto the under-pad. Many people find it easier if they are propped up on their side with pillows or up on their elbow.
  • When no more stool comes out, clean buttocks and rectal area with toilet paper and then soap and water. Dry well.
  • Flush toilet or throw out waste.
  • Wash hands.
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