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Thread: bowel help?

  1. #1

    bowel help?

    SO, I'm waiting for an appt with a gastroenterologist so that I can get a bowel program going. I had been on a simple one for a few months that has failed.
    The simple before: Just a suppository every night.
    However, since starting therapy on Aug 2, I tend to have a BM during 1000am therapy every wed and Friday . And getting worse. It seems that anytime I do a bit of movement it happens; such as transferring, balance work, using the elliptical stander, etc. I've stopped doing the bike before therapy because of the threat of a BM.
    I tried a clean out so I could sort of start anew. The said to do 64oz of miralax and take 2 senna tabs 2x daily. When I did the miralax I was only able to do 32oz over a 4hr period because of the gastric bypass I had in 2006.
    I only have 4 therapy days left of this session, then about a 4 month break before the next therapy session. I will be getting a elliptical stander at home and will still do that plus still work on my core and balance. I want to get my bowels situated before my next therapy session starts. There are some important therapies I can't do until I have my bowels trained.
    The problem right now.... I have to wait for the GI to look through my clinicals before they'll make an appt. The GI's secretary said it could take as much as 6 weeks before they make the appt. I don't want to wait that long.

    For now, I'm taking the senna, 2tabs twice daily. Any suggestions on what else I can do in the meantime?

    thanks for any help.

  2. #2
    You can start by reading this Paralyzed Veteran of America (PVA) publication: http://www.pva.org/media/pdf/cpg_neurogenic%20bowel.pdf

    A basic bowel program followed by many people with a spinal cord injury and neurogenic bowels consists of using a product like Magic Bullets (https://conceptsinconfidence.com) or Enemeez (https://enemeez.com/portal/product-tag/enema/) every other day, ideally at the same time day and about 30 minutes after eating a meal.

  3. #3
    It would help to know your level of injury, and if you have a flaccid anal sphincter (Lower motor neuron, LMN bowel) or a spastic anal sphincter (Upper motor neuron, UMN bowel). Having your level of injury on your profile makes it extra helpful.

    Who is the "they" who said you should take Miralax and senna? Did you not have a good program established when you went through your inpatient acute rehab program?

    Do you do digital stimulation or manual removal of stool?

    What kind of suppository? How soon after your evening meal?

    Most GI physicians are clueless in how to help you with SCI bowel management. A physiatrist who specializes in SCI would be better or an advanced practice rehab or SCI nurse. You will find more help here that at most physician offices.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4
    My spincter isn't flaccid (thankfully) & I'm able to push if told to, but I am unable to feel if anything comes out.
    My level of injury is T6 incomplete.
    When I say "They". It was about 12 months ago at Kernan in Baltimore. I did do some OT/PT there but not much. I don't feel like my care there was on par with my goals and I think my bowels was not a priority for them. I was inpatient and have not been in contact with them since I left in 10/2016. Now I do therapy at Kennedy Krieger in Baltimore. My Dr there is great, he thought maybe I might want to see a GI closer to my home.

    The only digital stimulation I get is when the aides clean me. They are here 3hrs in the morning to get me up & 3hrs at night when they get me to bed. It's not feasible for me to do anything stimulation or suppositories after I eat since the aide doesn't come until 530pm. Sometimes later. I do eat dinner around 5pm or so then go to bed when the aide gets here. The suppository I get is Fleet.
    thx~!


  5. #5
    I would recommend that you look into a Magic Bullet or Enemeez instead of the glycerine suppository (I have never had much luck using these). If you cannot do bowel care within 30 minutes after your meal, take a snack 30 minutes prior to your bowel care that includes some fat (such as butter or margarine or mayo) and/or a hot liquid (tea, coffee, etc.).

    Is it possible to get your attendant care at a different time? Do you private pay, or do you have some type of insurance or state program that pays for attendant care?

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  6. #6
    Senior Member
    Join Date
    Feb 2011
    Location
    Washington DC area--------------------T3 complete
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    146
    In rehab at National Rehab Hospital they were never consistent with the bowel program, hence I had a lot of trouble getting a routine. They did it at night so when I got home I tried to keep that routine. It never worked, always had issues while in the chair. We decided to try in the morning and it seems to agree with me. I still have the occasional accident, but they are rare. I'm surprised Dr. R didn't suggest the "magic bullet", as that is who suggested it to me. He also recommended Colace as a softener. I used to use colace 3 times a day then reduced it to two times. Since developing low iron levels I now take iron that has colace in it to help avoid constipation, which I take the day before my BP only.

    I do my bowel program M W F mornings *don't know if mornings are feasible for you or not* I also do my program in bed which is how they taught me in rehab. I do not have room for a potty chair so I have never even tried. In any event, my aid gets here between 8 and 8:30 am - she gets my morning medicines then gets breakfast, usually a bowl of cheerios. 15 minutes after eating we position me on my left side and she inserts a magic bullet then uses pillows to keep me propped on my left side. She then checks every 15 minutes and cleans up what is there and does a digital stimulation we do this every 15 minutes until I am done. This usually takes about an hour. Then we bathe and get dressed and into the chair.

    Do you think having the bypass has an affect on your bowels?

    Hope this helps - Good Luck !!

  7. #7
    I think I'm going to try something like Treeza's bowel program until I can see someone. What I would like to do is try it when my aide is here from 930am - 1230p. Do it before I get up from bed. then do the at home therapy I'm going to be doing (doing pretty much the same things I do at KKI). Problem is, I don't eat that early. Is kind of tough on my tummy. I want to do it before I do any therapy type stuff; therapy being my "gauge" as to whether a bowel program works since it seems that the most times I have an accident is during therapy when i'm moving a lot.

    Question(s): do I have to eat to do the magic bullet? oh and what exactly IS a magic bullet?
    Also, I could do it at night around 6pm when I go to bed, however would I be more prone to accidents the next day or will it work for the next day also?
    I plan on doing it every day to start.
    When I had my gastric bypass in 2006 it changed my BM's. They are softer and was having one almost every time I went to the bathroom, if even a tiny bit at times.

    thx~!!

  8. #8
    Member
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    Jan 2003
    Location
    Zephyrhills Florida, U.S.
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    36
    I am a T10 complete, left lower leg amputee. I take a stool softener every night and a suppository every other morning. 1/2 hr. after. I sit in my commode chair for 30 + min. till I have a BM. If after an hour. I don't have one. I do a shower which moves me around a lot sometimes making a BM. I watch what I eat, making sure I don't plug my bowels up or gain weight. I drink lots of fluids, morning decalf coffee and lots of decalf tea during the day. I eat 2 light meals and one good one at night. I need the light meals for my pill regiment.

  9. #9
    Senior Member
    Join Date
    Feb 2011
    Location
    Washington DC area--------------------T3 complete
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    Magic Bullet is a suppository - I get mine from conceptsinconfidence.com - recommended by Dr. R -

    Eating something gets the peristalsis going, which helps push your bowel down your intestine. Maybe you don't need the softener since you bowel was pretty soft since the bypass. I don't think it would matter if you did your BP in the am or pm, hopefully either way, once you get a routine, you won't have any accidents.

    I started out doing BP every day, but backed off to Mon Wed Fri when I was not producing any excrement every day. So far so good, *knock on wood* only occasional accidents.

    Hope this helps !

  10. #10
    Quote Originally Posted by Lisakaymd View Post
    I think I'm going to try something like Treeza's bowel program until I can see someone. What I would like to do is try it when my aide is here from 930am - 1230p. Do it before I get up from bed. then do the at home therapy I'm going to be doing (doing pretty much the same things I do at KKI). Problem is, I don't eat that early. Is kind of tough on my tummy. I want to do it before I do any therapy type stuff; therapy being my "gauge" as to whether a bowel program works since it seems that the most times I have an accident is during therapy when i'm moving a lot.

    Question(s): do I have to eat to do the magic bullet? oh and what exactly IS a magic bullet?
    Also, I could do it at night around 6pm when I go to bed, however would I be more prone to accidents the next day or will it work for the next day also?
    I plan on doing it every day to start.
    When I had my gastric bypass in 2006 it changed my BM's. They are softer and was having one almost every time I went to the bathroom, if even a tiny bit at times.

    thx~!!
    Magic Bullets (https://conceptsinconfidence.com) are bisacodyl suppositories in a polyethylene glycol (PEGBS) base. Other bisacodyl suppositories, i.e., Ducolax have a hydrogenated vegetable oil (HVOBS). The PEGBS base is water soluble and the suppository melts quicker which helps to stimulate peristalsis that moves stool through the colon.

    A typical bowel program should begin by removing stool from the anal vault. Insert the suppository. Wait 10-15 minutes. If nothing has happened, digital stimulation is suggested, usually every 5-10 minutes. The program should take from 30 minutes to an hour. One of the drawbacks of the Magic Bullets is what is sometimes called "after burn," which is mucus that is expelled after the bowel program is completed. It helps to due enough digital stimulation to remove any residual suppository and to make sure that stool has been thoroughly evacuated.

    It helps if you can eat something about 30 minutes before a bowel program, using any method, and it may help if you can have a hot drink like tea before you start.

    Everyone is different. Some people have no luck at all with a morning program, and when they switch to an evening program, things work better. That said the opposite can be true too.

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