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Thread: Trying to be independent with bowel program, and failing.

  1. #1

    Trying to be independent with bowel program, and failing.

    Starting Wed. I've been doing my own bowel program. I'm not doing so great.

    The first day, Wednesday, I put in the supository using the inserter device. I stayed in the bed 2 minutes, then transfered over to the shower/comode chair. I wheeled into the bathroom as fast as I could and parked over the toilet. I sat for an hour and did nothing.

    When I got back in bed, I found out why, the supository fell out and landed on the seat. I put on a diaper, got dressed, and luckily I did not have an accident that day.



    Thursday, I got on the chair first, then reached behind and put in the supository with the inserter, and then backed over the toilet. I sat about 5 minutes, and then started passing gas. I could see small peices of the melted supository that came out with the gas floating in the toilet, but it wasn't enough to be the entire thing.

    Finally after sitting about 30 min, a couple of lumps fell out. I sat a little bit longer, then I went ahead and rolled into the shower, took my shower. I got dressed, and went the whole day without an accident.


    Friday is when the problems started. I did exactly as I did thursday, with about the same results. I went all day without an accident.

    There's this "feeling" I get when I either need to cath or do a BM, but I can't tell which. I was getting ready for bed, and I got that feeling. It was time to cath anyway, so I cathed. I didn't cath much, and then I realized it was the other "feeling."

    By then it was too late, I'd already messed my shorts. I only put on boxer shorts when I'm around the house, and I'll put on pants later if I go somewhere. So all I had on were the boxer shorts. I was about to get in bed, and clean up, when I started getting the "feeling" again, and I knew I wasn't done. I though I'd be smart, and put the shower chair over the toilet and transfer to it and let it all go in the toilet.

    Bad idea. Mid transfer, the load (and it was a huge runny load) that was in my shorts, came out of the left leg of the shorts and fell on the floor and the front caster of my wheelchair. Good thing I wasn't wearing long pants or it would have ended up in my shoe. I didn't get the shorts off in time, and I did another large load in them while sitting on the shower chair.

    To make a long story short (or is it too late for that), I didn't get to bed until after 5am because it took so long to clean that mess up.

    That brings me to today, Saturday. I do the same routine, had a small BM, but I was expecting that considering the amount that I produced the night before. I sat there for 45 minutes to be safe, but as I started wiping myself, a little more came out.

    I know some people have to do that digital stimulation thing, but I'd never had to do that before. I don't know exactly how it's done, but I tried it. I put on gloves and tried, but the fingers on my right hand won't straighten out, and the ones on the left hand just weren't strong enough to get the job done. So far today, I haven't had an accident, but the day isn't over.



    The way I had beend doing my BP was my assistant would insert the supository, and I'd lay in bed 5 minutes then transfer to the shower chair. I'd start going as soon as I got on the chair, and 10-20 minutes later I'd be done.

    In order to park the shower chair over the toilet, I have to remove the bucket and bracket that is there to catch the "stuff." I also can't reach under to clean myself up with the bucket and bracket in place.

    Even though I'm putting the supository in while sitting up, it is staying in and not falling out, but why am I not getting the same results as when I lay down for 5 minutes and then sit up? How do those of you that can, do your independent BP?

    _____
    Learn from the mistakes of others, you won't live long enough to make all of them yourself.

  2. #2
    Senior Member Kaprikorn1's Avatar
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    Jimns...

    How far post are you?...what level...I'm L1 but have been doing BP for 22 months. I had mucho diaherrea at first...then went the other way...then back after about 6 mo's...now back to constipation mode. I am ambulatory and don't use supp's but do dig stim and have to do a lot of "helping" BM's out b/c my anus sphincter is so tight. You can do dig stim with the "facilitator" if your fingers won't work...just insert gently and make circles inside your anus...after a couple min's...just relax and wait..it'll happen...especially if you relax. If no results...try again. When you wipe it stimulates peristasis and you'll sometime get almost done then have another bm. hope this helps...get used to cleaning up messes...it sux but it's all part of the deal.

  3. #3
    C8 complete, 17 months post.

    _____
    Learn from the mistakes of others, you won't live long enough to make all of them yourself.

  4. #4
    Suspended Andy's Avatar
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    I dont know how weak the fingers are on your left hand, maybe they are strong enough to 'open the door' so to speak, maybe not, but this is my BP...

    I dont use suppositories, they have a nasty habit of continuing to work for several hours on me causing accidents sometimes, so I stopped that shortly after rehab. I insert 1 finger and wiggle it around for about 15 sec. until I feel the tip of the turd at the tip of my finger. Right around then my sphinter starts to loosen up and I get a second finger in there, and open the door up. I inhale all that I can and hold it so my diaphragm pushes down on my innerds to help squeeze out the turd, and a nice log ends up in the crapper. I then go in again to finish up the job and get the little bit that is left, usually it is just a wee bit (my fingers are long enough to feel the opening of my intestine so I know my rectum is empty) and call it a day. Done daily this works well for me. Sometimes if I am corked up I have to help the log out, but that isnt too often. Barring eating something nasty that causes diarreah (I really wish I could feel if I am 'unsettled'), no accidents. Of course this might not work for you depending if you can open the door or not with 2 fingers, but I thought I would throw out this idea.

  5. #5
    It seems that you will need an enema to facilitate your BM or You can use a small water hose inserted in the anus at a reasonable rate to facilitate the BM.
    This works well & empties all of the rectum contents for 2 days.

  6. #6
    Senior Member
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    Might want to try the small bisacoyld(?) fleet enemas. With your limited hand function perhaps you could squeeze it. I have used them for over 20 years. I squeeze it in then hop into my shower chair and roll over the toilet. They work in about 10 minutes and do a great job. Although they are a little more expensive, the quality of life and peace of mind they provide are priceless. I drink lots of water, and eat a high protien diet. I take two Senakot at 1:30 PM and do my program at 8:00 at night. If by chance I do have an accident it happens at night, not usually during the day when I'm at work. It works for me and keeps down the frustration factor.

  7. #7
    I have a similar level and amount of function and this is what I do. I haven't had an accident (except for a few in the week after after delivering my daughter) since rehab. I'll write it out step by step so you can try it.

    1. Do ROM
    2. Insert suppository in as far as it will go while lying on my side - wait 5 min or so then get on my commode (a grey and chrome E&J with side cutouts) but I don't use the bucket. Then I wheel over the toilet as fast as I can!
    3. After 10-15 minutes gas and melted suppository starts to come out.
    4. Soon after a lot of poop comes out.
    5. I wait until none has come for about 10 more minutes then do a 'check' with my dig tool. If theres anything else this relaxes the sphincter so it can come out.
    6. If more came out I repeat step 5, if not I wait 5 more minutes and wipe up.

    ***BUT*** THE MOST IMPORTANT/NESSECARY THING I HAVE TO DO IS DRINK OR EAT SOMETHING HOT WHILE I'M SITTING ON THE COMMODE!!!!!!!!! If I don't the routine fails miserably.

    Some other tips are: make sure you are sitting comfortably - I usually spread my butt cheeks to open the sphincter a bit ; relax when you feel it coming down (if you can feel) ; lean to the left and push on your lower left abdomen (this is where your rectum is).

    "Learn from yesterday, live for today, hope for tomorrow"
    ~ Anon

  8. #8
    It is very difficult to use either a mini-bisacodyl enema or an Enemeez independently without full hand function.

    Have you tried doing dig stim without a suppository? Many people do well this way, and it would eliminate the suppository problem. I would also think about changing to Magic Bullets if you are not using them already. They work faster so you can insert on the commode easier.

    Regular bisacodyl suppositories will always come out melted. This does not mean they are not working. You are seeing the residue waxy material which must come out either together with or separate from the stool.

    I would endorse doing bowel care after eating a hot meal or hot liquid (within 30 minutes) to utilize the gastrocolic reflex. Recent studies have also found that including some type of fat in this meal makes it more effective. This could include margarine on toast or milk (not non-fat) in your coffee, or drinking hot chocolate.

    Routine use of enemas is not recommended for people with SCI.

    (KLD)

  9. #9
    I thought I did good today. I started out as usual, on the char, over the toilet, and inserted the supository.

    My left hand is a little better, so I gloved it up, then managed to push the supository farther up. About 30 seconds later I hear a "ploop." I look and there's the supository, but then two turds come out right after it.

    I waited a few minutes and nothing happened, so I put in another supository. Gloved up my left hand, and pushed the supository up as far as I could and held it there until I didn't feel it anymore.

    After I removed my finger, and maybe 5 minutes later, things started falling out. I did a pretty good bit this time.

    After I was done, I wheeled into the shower, and took my shower. My shower chair has pneumatic tires, and they've been low. I kept forgetting to air them up, so after my shower, I wheeled to the airpump and filled them up. Then I got in bed, dressed, and in my chair.

    Then two hour later, I craped my pants!

    I used to do my BP at night, but I was having too many accidents during the day, thats why I do them first thing in the morning. I also have to go every day.

    Before I started trying to do this myself, my PCA would put in the supository, and I'd lay for 5 minutes, then as soon as my butt hit the chair I started going. So there's no way I can insert the supository while in bed, then transfer to the chair and make it to the toilet without making a mess.

    What are these enema things, and how do they work?

    DrNader, please explain more on this water hose process.

    _____
    Learn from the mistakes of others, you won't live long enough to make all of them yourself.

  10. #10
    Senior Member
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    The mini bisacoydls are made by fleet, come in an orange box and are like a liquid supository.Although SCI Nurse says they are not for regular SCI use. I have used them for 20 years with no problems and very few accidents. Its a quality of life issue. Doesn't sound like you are having a lot of fun with what you are doing. Nothing worse than dealing with bowel accidents. The fleets are 1.25 oz, are at most drug stores or can be ordered in one day.

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