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Thread: enemas

  1. #1

    enemas

    Hi i have a carer that does my bowels for me she puts a finger in my bum first and then she puts a enema up when this has worked she says she has to put anther in is this right how meny can you have at the moment she does it once a week

  2. #2
    Does this caregiver have any special training in SCI? Does your district nurse, and can she help train this person?

    Routine use of enemeas should be avoided, as it is a major risk factor for developing long-term megacolon.

    Do you use a suppository? What type?
    How much fluid do you take daily?
    What type?
    How much dietary fiber are you getting daily?
    Do you stand daily?
    How about other exercise?
    What other meds are you taking?

    It is strongly recommended that bowel care be done no less frequently than 3X weekly. Less often is also correlated with megacolon development.

    Is she manually removing stool with her fingers or doing digital stimulation? Neither should be done with more than one finger. Don't allow two. Most people at your level use a suppository to bring stool down into the rectum, then digital stimulation to get it evacuated. Evacuation will be better if you do it on the toilet or commode.

    I would also recommend that you download and read this booklet about SCI bowel care, and follow the guidelines listed there:

    Neurogenic Bowel: What you should know


    (KLD)

  3. #3
    Hi no i do not use any suppository and i dont have a standing frame i eat two meals a day and some fruit some days not evry day i drink lots of tea in a day10 mugs a day some times when she does manual ther are bits but its mostly one day a week when she gets best result how long do you use a finger up bum when doing manuals she has no special traineing in SCI why is it better over a toilet to do it and how do you get hand under to do it and what is megacolon how meny suppository do you use at a time and which are the best ones i am in the U.K.

  4. #4
    Yes, I know you are in the UK. Americans don't use the word bum.

    i drink lots of tea in a day10 mugs a day some times
    The tannin in tea is very constipating. I would encourage you to drink more water and less tea.
    when she does manual ther are bits but its mostly one day a week when she gets best result
    Every other day or Monday/Wednesday/Friday or Tuesday/Thursday/Saturday are much safer routines for bowel care than weekly. If your stool sits in your gut that long, it will be very hard and dry (constipation) which is probably why you are requiring manual removal of stool (disimpaction actually).
    how long do you use a finger up bum when doing manuals she has no special traineing in SCI
    There are directions on how to properly do digital stimulation (not manual removal) in the booklet I mentioned above. Did you download it and print it for her?? For most people, digital stim is done for up to 5 minutes at a time, then rest, then repeat up to 5-6 times until the rectum is empty.
    why is it better over a toilet to do it and how do you get hand under to do it
    Gravity helps significantly both to move stool down through the entire colon (which is why standing is also important), but also helps to make evacuation more complete (no accidents later) and faster. I generally estimate for most people that bowel care in bed will take 2-3X the time that it takes to do it on a toilet/commode. Most people either use an over-toilet commode or a raised toilet seat that allows easy access to the anus for this.
    what is megacolon
    This is a large, overstretched bowel that has lost all of its muscle tone. People with SCI who have allowed the stool to stay in the colon for prolonged periods of time, over-used stimulants and laxatives, and used regular enemas are the most at risk for this condition, which is actually called obstructive megacolon.Symptoms are prolonged transit time (well over 72 hours), bowel care taking over 2-3 hours, and distension and stool just not moving through the colon. Sometimes use of more stimulants will help, but often elective colostomy is the only option. Better prevented than treated.
    how meny suppository do you use at a time and which are the best ones
    There is no one best suppository. Try generic bisacodyl suppositories first. If those don't work well for you, I would suggest getting the Magic Bullet brand, or trying Enemeez. Not sure how easy it is to get these in the UK.

    (KLD)

  5. #5

    Smile

    hello

    i'm a C5--5 quad

    bisacodyl suppositories do not work for me , and my friend who is also the nurse who takes care of me , uses the fleets to do my bowel program 3X a week ( wednesday , friday and sunday )

    is that bad enough to cause megacolon ?

    lola

  6. #6
    Over time this could be problematic. Have you tried either Enemeez or Magic Bullets? Do you also do digital stimulation? If your friend is not a SCI or rehab nurse she may not be familiar with how to do this properly. I would also recommend that you download and read the booklet above, and share it with her.

    (KLD)

  7. #7
    Hi i have a clos-o-mat tiolet no room to do digital stimulation can you do it while in a cilling hoist over shower or bath

  8. #8
    If you are comfortable hanging in the ceiling lift for up to 30-45 minutes, yes, you can do this.

    (KLD)

  9. #9
    Hi i keep getting leaks my penis keeps retracking i think that what they call it getting smaller

  10. #10
    Quote Originally Posted by kennyren
    Hi i keep getting leaks my penis keeps retracking i think that what they call it getting smaller
    Hi Kennyren,

    In men this is referred to as the "shrinkage factor". I personally coined the term. When most men get heavily bacterially colonized or have a UTI (Urinary Tract Infection) this is one of the results. Go to your doctor and have a Urinalysis and a Culture & Sensitivity (C&S) done and he or she will probably prescribe you some antibiotics to start taking "on the spot". Then when the results from the C&S return in 3-5 days they may change the antibiotic to one that is most effective at killing whatever bacteria is infecting your bladder.

    However, treating UTIs is different in Spinal Cord Injured (SCI) people than in the able-bodied population. Please tell your doctor this. Below are the guidelines as presented by Nurse KLD.

    Positive cultures are not UTIs, and should not be treated unless you have a fever, chills, elevated white blood cells, etc. If you treat your positive cultures (which will pretty much be all the time), you risk getting a drug resistant bug that can't be treated easily when you really do get a UTI.

    This is detailed in this report, which serves as a clinical practice guideline for knowledgeable SCI urologists and physiatrists:

    http://www.ncbi.nlm.nih.gov/books/bv...1.chapter.8279

    (KLD)
    If you have a printer, print out the information provided at the link above and give it to your doctor or urologist. But usually when I get the "shrinkage factor" it's enough for me to start taking Cipro or Levaquin to cure my UTI or heavy colonization. Or whatever antibiotic I have most of at the time... I always keep a "stash" of them here. But you really shouldn't take antibiotics unless you have the above criteria of "fever, chills, elevated white blood cells, etc." but that's up to you and your doctor.

    Good luck.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

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