Bowel Programs

Stool will regularly need to be removed regardless of the level of injury so a bowel program based on the individual bowel type is needed.

A Reflex bowel program

can be done every day, every other day, or even as rarely as 3 times a week. There are 8 general steps:

Step 1 Wash hands thoroughly.

Step 2 Prepare your supplies. You will need:

  • gloves (powder and latex-free)
  • lubricant (water-based or anaesthetic only)
  • toilet paper
  • stimulant
  • assistive devices (a suppository inserter, finger extension, digital stimulator)

Step 3 It is best if you sit on a toilet or commode chair so that gravity can help move the stool. If this is not possible you can lay on your bed with your body turned on the left side. Use underpads. Do not use a bedpan as it could potentially cause damage to your skin.

Step 4 Manually stool removal. The lining of the rectum is delicate, so insert a gloved, lubricated finger into the rectum and gently hook your finger around any reachable stool and remove it.

Step 5 Insert rectal stimulant as high as you can into the rectum.

Step 6 Sometimes referred to as “Digi-stim,” the process of digital rectal stimulation promotes the muscle contractions that move the stool down through the rectum as well as the relaxation of the sphincter muscle. It is best to begin digital rectal stimulation once the stimulant has started to work. This could be anywhere from 15 to 30 minutes after insertion. At this time, you can insert a gloved, lubricated finger into the rectum and gently start moving that finger in a circular pattern for 20 and up to 30 seconds at a time. Be sure to keep this finger in contact with the rectal wall for the duration of the process. This process can be repeated every 5 to 10 minutes until the BM is complete.

Step 7 The individual needs to be able to recognize when the BM has finished. If there is no more stool after two consecutive digital simulations, if mucus coming out without any stool, or if the rectum is closed tightly around the finger, then the BM has likely been completed.

Step 8 Clean up. Wash and dry the anal area.

A Flaccid bowel program

is usually done at least once daily. There are 6 general steps:

Step 1 Wash hands thoroughly.

Step 2 Prepare supplies. You will need:

  • Gloves (powder and latex-free)
  • Lubricant (water-based only)
  • Toilet paper

Step 3 Get into position. Most individuals are able to sit on a toilet seat or commode chair.

Step 4 Manual stool removal. Stimulants are not usually effective for a flaccid bowel, so a manual removal of stool must be done about every five minutes until the BM is done. Between each 5-minute removal period, it is possible to promote stool movement through digital rectal stimulation by firmly rubbing your abdomen in a clockwise direction with your hand, leaning forward and from side-to-side, body push-ups, and the tightening and releasing of abdominal muscles.

Step 5 The BM is most likely finished when there are no stool results after two manual removals.

Step 6 Clean up. Wash and dry the anal area.