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Thread: Reducing Time for Bowel Movements

  1. #1

    Reducing Time for Bowel Movements

    Bowel movements? Everyone's favorite topic!

    Some background info: I am a C4/5 Quad complete, 11 years post injury. I do my bowel routine three days a week in the evening, always at the same time (~7:20 PM). I use Enemeez as of two years ago? It was a great change from the Magic Bullet! I put the Enemeez in while on my side in bed, and then I quickly transfer to the shower chair and get over the toilet. If nothing substantial has come out within 10-15 minutes, I use a little digital stimulation to evacuate whatever is right there. This makes sure that there is nothing especially firm holding up the process. From then on I use digital stimulation every 5 minutes unless my body is evacuating on its own. The checking (digital stimulation) continues every 5 minutes until the sphincter/colon starts to close up and the glove is clean. My tolerance for dirtiness of the glove increases if the bowel routine that night goes especially long.

    I have always been told by those in the spinal cord field that 30-45 minutes is the goal for a bowel routine. I chuckle at that number. Mine used to be 45-60 minutes, with the occasional long program. Lately, my average has been about 75-90 minutes. I get very good evacuation toward the start, and then my body seems to wait to release the last few little bits. Often the last 30 minutes is just spent waiting to move out something the size of a large grape. I tried taking senna, but it didn't seem to help hurry along this last part. The advice always seems to be, "Eat plenty of fruits and veggies, and drink plenty of water." I drink plenty of water, and my fruits and veggies intake is as high as I can get it. I also get plenty of fiber.

    For many reasons, I would love to reduce the amount of time I spend sitting on the toilet! One of the biggest reasons is to ease my hemorrhoids. I've earned some pretty significant hemorrhoids over the years, and I was even considering surgery a few years back. Since realizing that I was an adult and forced myself to adopt a high fiber diet, I've been able to minimize the amount of bleeding. Nonetheless, I'm sure I could get my hemorrhoids to shrink a little if I cut down the time spent on the toilet. Any suggestions?

    I saw a recent reply post by the SCI Nurse saying that digital stimulation is not recommended at all. Is that really the case?

    Thanks for listening.

  2. #2
    Senior Member dnvrdave's Avatar
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    Quote Originally Posted by EyesOfTexas View Post
    ... Nonetheless, I'm sure I could get my hemorrhoids to shrink a little if I cut down the time spent on the toilet. Any suggestions?

    I saw a recent reply post by the SCI Nurse saying that digital stimulation is not recommended at all. Is that really the case?
    I think SCI Nurse said dig stim was not recommended at all at one particular hospital, after the patient had a hemorrhoidectomy.

    I have 2 suggestions: 1) A hot wet wash cloth (for about 5 minutes) helps to shrink the hemorrhoids; 2) Consider getting a colostomy.

  3. #3
    Senior Member WPDaggy's Avatar
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    Years ago, after leaving rehab, I used a suppository while sitting in a shower chair and having digital stim done. It took about 45 minutes on average. Problem was those days when results didn't come . . . until several hours later when I was dressed and in my chair. Great times. ;-) I did it that way for three or four years, before finally figuring, this kinda sucks, so decided to skip the suppository and just go with digital stim and nothing else. I have been doing it on my side in my bed ever since. I have good results nearly every day (yes, I go daily), and it takes about 10-15 minutes from the roll onto my side to the roll back onto my back after clean-up. I think I just trained my body. Going daily is a bit of a pain, but I do it when I go down for the night. And I do have to at least check it every night, otherwise I'll be uncomfortable the next day if my cavity was full and didn't get emptied.

    Maybe try something similar to what I do, going at whatever interval you'd like. It may train your body to be more regular on its own.
    2010 SCINet Clinical Trial Support Squad Member
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  4. #4
    sorry this is frustrating for you

    My suggestions:

    1) You may want to consider a daily bowel program to reduce the length of the program
    2) may sure you have eaten something or a hot beverage prior to the program to stimulate the gastrocolic reflex
    3) My rule of thumb is that if it takes you longer than 2 hours to do a bowel program then you should re-visit how your program is going.
    4) dig stim is fine (I mentioned previously that a surgeon who performed hemorrhoid-ectomies advised against dig stim after the surgery)
    5) are you sure you are not constipated? have you had a colonoscopy? any blood in stool (not bright red but dark that is mixed in with stool)? any stomach issues? history of irritable bowel syndrome? ulcers?

    pbr

  5. #5
    Thanks for the suggestions.

    I have briefly in the past thought about getting a colostomy, but my understanding is that they don't hold in the poo stench as well as you would hope. I'm also still a single guy. Attracting women is difficult enough from a wheelchair, I think I'll forgo the colostomy until I need it!

    Daggy, that's an interesting approach. I've considered the option of going every day (or close to it), but I still weigh the pros and cons. Like you, I go every evening. Until a couple of years ago, I did my programs in the morning, but I just started full-time work a couple of years ago. Getting up extra early to do a bowel routine and budget extra time for its uncertain length was not going to work! That said, the downside to doing evenings is that it's hard to have a normal weekend if I've got to come home early enough to do the program. Going three days a week in the evening is nice because I can go Sunday/Tuesday/Thursday.

    That said, I'm not completely disregarding your advice. Any idea how long my body would take to equilibrate with a daily bowel program? Generally my body makes adjustments pretty easy; I don't have accidents often. How long would I have to try a daily bowel program before seeing its time benefits? Could there be any reality to "trying it out" for a week or two?

    To address the rest of the nurses comments:
    -I generally eat dinner and not too long before my bowel routine, and I often drink a glass of warm water after getting on the toilet. I'll try to make that a more regular occurrence.-
    -2 hours is what I would characterize as a FREAKING LONG PROGRAM. Luckily I hardly ever go past 90 minutes.-
    -I'm pretty sure that I am not constipated. Other than the occasional streaks of blood from the hemorrhoids (that is bright red), I don't see darker blood mixed in the stool. I don't think I have stomach issues or irritable bowel syndrome? I have not had a colonoscopy yet. I am 30 years old. At what age do you typically recommend SCI patients should have a colonoscopy? Is it any different than able-bodied people?

  6. #6
    Senior Member WPDaggy's Avatar
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    Texas,

    It's been about 15 years since I started the daily routine. I know it wasn't long before I'd trained my bowels (they called it bowel training in rehab) to go daily. There are days I'm empty--rarely--and if that's the case, I'm wiped with a baby wipe, and done. My advice, because it worked for me; stop with the Enemeez and do your routine with dig stim, every day, every three days, whatever you want, and if your cavity is empty, wait a bit, stimulate again, if nothing, call it a day. If you're not constipated, your body will go when its ready. You shouldn't have accidents if you stay away from the suppository, at least that's been my experience.

    My routine: caregiver puts me in position, stimulates me, empties the cavity, waits a minute or two, checks the cavity again, if more has come down, stimulates again, and then repeats until empty. Generally I'm empty after the first or second time. Clean up and done. Every once in a while I go and go and go, but those days are rare.

    Best wishes, buddy . . . and Go Cowboys!
    2010 SCINet Clinical Trial Support Squad Member
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  7. #7
    I would agree that trying an every day program is probably a good idea. You can always go to every other day, but my experience is that any longer than every other day can cause longer bowel programs.

    I do get that you don't want to be controlled by your bowels and you shouldn't be. However, you may need to make some adjustments - over time that does happen.

    I would suggest that you keep a "bowel diary" for a couple of weeks. Try to keep track of what you eat and drink, when you start your bowel program, and what occurs when. You might see a pattern emerge that you can build on. I would also encourage you to have a warm drink before starting the program - and to take a look at the medications you may be on. Any changes recently?

    Hope that this helps.

    CKF

  8. #8
    I realize it's 2 1\2 years later but I can relate. C4 quad post 32 years, here. I read on this forum many, many years ago about some bowel vacuum or flush-out system or machine that made the bowel program really fast, efficient, cleaner and no/less smell. Everything traveled by tubing into a collection machine. Does anyone know or remember what I'm talking about? If so, what is it called and did it really work without damaging the body?

  9. #9

    Bowel Evac Vacuum

    I read on this forum many, many years ago about some bowel vacuum or flush-out system or machine that made the bowel program really fast, efficient, cleaner and no/less smell. Everything traveled by tubing into a collection machine. Does anyone know or remember what I'm talking about? If so, what is it called and did it really work without damaging the body?

  10. #10
    These devices are known as Pulsed Irrigation and Evacuation (PIE or P.I.E.). I don't think these devices are approved by the FDA for use in the United States. Medicare and many private insurance companies do not cover the cost of the devices or supplies, as these devices are considered experimental. These devices have been discussed on this forum and there have been a few advertisements for units/supplies for sale and want ads.

    Long-Term Safety of Pulsed Irrigation Evacuation (PIE) Use with Chronic Bowel Conditions
    http://link.springer.com/article/10....:1018808408880

    Neurogenic bowel dysfunction after spinal cord injury: Clinical evaluation and rehabilitative management
    http://www.sciencedirect.com/science...03999397904160

    Neurogenic bowel management after spinal cord injury: a systematic review of the evidence
    http://www.nature.com/sc/journal/v48...sc201014a.html

    All the best,
    GJ






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