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Thread: Bowel management - usage of shower.

  1. #1
    Senior Member
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    Bowel management - usage of shower.

    Bowel management.

    I had an Intraspinal Arterieovenous Malformation (AVM) and Myelopaty (narrowing of the spinal channel due to the AVM) at level Th4 - Th8. I had surgery in 2002 and the AVM was removed. Due to the AVM my spinal cord is damaged at chest level and I have problems with sensation and motor signals below that level. I have to use a wheelchair on a daily basis but I can stand upright on my legs without support for a few minutes. I can also ambulate for some 30-40 yards on crutches.

    As I know by reading on the Internet, communicating with peoples on the Internet and by personal experience bowel problems due to an SCI is a major issue.

    When I was going to have surgery to remove the AVM one of the concerns was if I would loose control of the bowel system totally. As one surgeon told me "The problem for many of my patients is not be able to walk as it is for loosing or getting problems with the bowel system".

    I know that a good diet is an important matter for a good bowel program, the same with having enough fluids/water during the day. For matters like this I think I am doing fine and as I should do. Well - maybe I could drink more water.

    Above that I have problems with my bowel system. I have tried several options for emptying the bowel, but none has fully worked to my satisfaction.

    I have normal strength in my upper body. I have a spastic anal sphincter.

    At first for emptying the bowel I was sitting on the toilet seat and stimulated rectum, this procedure helped some, but I was not able to empty the bowel fully.

    Finally I came up with an idea for a procedure that has worked fine for me: When I am having the bowel program I park my wheelchair close to the shower cabinet. I have made some handles on the cabinet so that I am able to "walk" into the shower cabinet.

    Inside the cabinet I have a plastic chair witch I have cut an opening into seat. Sometimes if I am very fatigue I use this but in general I am standing when having the bowel program. By standing I will also get help from gravitation.

    What I do is to stand upright, holding me with the right hand while I use the shower handle (witch is connected to a flexible hose) with the left hand. The temperature is adjusted to warm water (40C-45C, 104F-113F). Above that the shower handle has a button switch I can switch to massage position. The massage position on the shower handle does send a pulsating narrowed beam of water. I then aim the pulsating beam of warm water directly to the rectum, holding it 4-5 inches from it. This stimulates the sphincter to open after just a few seconds, when the sphincter opens the warm water also has a stimulating effect, and it will now flow up the rectum. After a little while the bowel system will empty totally. If not, I just sit down for a minute or two and am doing the same procedure again - then it will empty totally. Then since I'm already in the shower I use the shower to clean myself.

    For the stool inside the shower cabinet it is not a problem. I just remove the grating on the drain and the filter below prior to the procedure. I flush all down and use a disinfectant spray to clean the cabinet after.
    I have done this procedure for over a year now and it is working fine. I have not harmed the skin, nor have I harmed the sphincter and it has helped me a lot. I have not found any side effects by this procedure and it has helped my daily life enormous.

    Well, enough of this difficult subject. Hopefully it can be a tip. I know it would not help in all cases, but for me it has been a great procedure. If there can be any hazards with this procedure, please let me know.

    Leif

  2. #2
    You are essentially giving yourself an enema under pressure. I know this technique has been used in some third world countries (I ran into people using it in Brazil, for example). I would just caution you that using a lot of water pressure into the rectum, and repeated use of enemas can over the long term (years) cause problems with you bowels such as megacolon. I would not recommend it in general.

    (KLD)

  3. #3
    Senior Member
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    SCI-Nurse

    Thank you very much for your concern and advice. I was not aware of that my bowel procedure could lead into such serious problems for the colon as for instance the syndrome megacolon as you mentioned.

    Up to now I have not studied the problems related to a neurotic bowel system in detail due to the method I have used so far has worked perfect for me. - I am glad I posted the piece here in this forum and from now on I will look into other means of managing the bowel - due to the hazards involved.

    I have some questions:

    I know by some studies I have done here today that the water pressure is not a good idea, since I understand this can cause expansion of the colon and lead to megacolon.

    If I reduces the water pressure. Will I then be able to do what I have done so far in a more moderate way? Or is the water up the colon itself a problem, since this basically also is an enema as you describes? Will this for instance make the colon "lazy"? Or in fact, do you mean that I shall stop all of this?

    Well, thanks a lot again. I take your point.


    Leif, - from the Old World

    "Isn't there any easy ways of dealing with SCI problems? I thought this one was one!"

  4. #4
    SCI Nurse

    I had this happen while in the rehab. They were giving me a shower and the water hit me and automatically my bowels moved. It was not held there, just brushed past, but it really grossed me out having it happen while in the shower.

  5. #5
    Gentle use on the anus to relax the sphincter should be fine, but I would avoid having the water actually irrigating the rectum. The megacolon development appears to be a combination of over stretching and the bowel becoming "lazy" as the colon muscle stops working with this condition.

    Some people swear by the PIEE machine, but I have some concerns because of the lack of research on long-term use.

    (KLD)

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