Bowel Management

A satisfactory program for preventing constipation requires trial and error, time and patience. Keep in mind that bowel management is different for everyone. For example, some medications like painkillers are known to cause constipation, so people who have recently undergone surgery are more likely to experience problems with constipation. It is important to keep trying various methods until you find a successful program.

Goals for Bowel Management

1. Emptying the lower bowel at regular intervals.
2. Preventing accidents between regular emptying.
3. Preventing constipation.
4. Promoting independence.

Methods for Bowel Evacuation

You can use a variety of methods to help prevent constipation. Check with your doctor about which methods are best for you. If medicines are needed, such as suppositories or laxatives, your doctor or clinic nurse can help you decide which to use. Let your doctor or clinic nurse know if the method you are trying is not working. Beyond that:

• Drink plenty of fluid - This causes the intestine to contract and moves stool down to and out the large intestine.
• Natural laxatives - Foods such as peaches, pears, papaya and prunes are natural laxatives that trigger a bowel movement.
• Stool softeners - These prevent the hardening of stools and can be taken on a regular basis.
• Suppositories - A suppository is a medicine that is inserted into the rectum. It stimulates the bowel and causes it to contract. When inserted, the suppository should come in contact with the rectal wall.
•  Digital stimulation - Insert a gloved finger about 1/2 to one inch into the rectum and use a gentle circular motion for one minute to stimulate the bowel. This relaxes the sphincter (rectal muscle) and allows for movement of the stool.
• Laxatives - A laxative is a medicine, either in pill, liquid or suppository form, that also stimulates the bowel, causing it to contract and move stool out of the intestine.
• Manual evacuation - Removing stool within the rectum with a gloved finger may be necessary if other techniques are not successful.
• Enemas - liquid is injected into the intestine through the rectum to stimulate bowel emptying. Enemas stretch and irritate the bowel, causing it to contract. Enemas are usually one of the last choices for the treatment.

Helpful Tips

1. Sitting is better than lying down for a bowel movement. If your feet don’t touch the floor when sitting on the toilet, put a box or footstool under the feet so your knees are higher than the hips. This squat position helps promote bowel emptying. If your child can not sit on a toilet, try repositioning. Putting a child in a stander, for example, can be helpful.
2. Start a new routine with an empty bowel (a very mild laxative or small enema could be given to clean the bowel).
3. Diet is very important. Foods containing fiber such as bran cereals, whole-grain bread, fruits (especially peaches, prunes, pears, plums) and raw vegetables help stimulate the bowel by adding bulk to the diet. Limit foods that cause constipation like chocolate, cheese and bananas.
4. Drink plenty of fluids, especially water and fruit juices, to keep the stool from becoming hard. But limit fruit juices to 4-8 ounces a day.
5. No more than three days should be missed without a bowel movement.
6. Clean the skin well after each bowel movement or accident. This prevents skin irritation.
7. Activity is essential for normal bowel function. Inactivity tends to slow bowel function. Regular physical therapy or other forms of exercise will help improve bowel function.