From the Guidelines
Digital stimulation for bowel programs should be performed by inserting a lubricated, gloved index finger into the rectum approximately 1-2 inches, moving in a circular motion for 15-20 seconds, then resting for 15-20 seconds, and repeating until bowel movement occurs or for a maximum of 20-30 minutes. The procedure begins with proper hand hygiene and donning gloves. The patient should be positioned in a left lateral or seated position on a toilet or commode. Apply a water-soluble lubricant to the gloved index finger. Key considerations for the procedure include:
- Maintaining the patient's dignity and privacy
- Monitoring for signs of autonomic dysreflexia in patients with spinal cord injuries above T6, which may include sudden hypertension, bradycardia, headache, and flushing 1
- Performing the procedure at consistent times, typically 30 minutes after a meal to take advantage of the gastrocolic reflex, as suggested by the american gastroenterological association medical position statement on constipation 1
- Enhancing the procedure with the prior administration of stool softeners or suppositories as prescribed, such as bisacodyl or glycerol suppositories, which can be administered 30 minutes after a meal to synergize with the gastrocolonic response 1. This technique works by stimulating the rectum, which triggers peristalsis and relaxation of the internal anal sphincter, facilitating stool evacuation. Some patients may require additional interventions, such as biofeedback therapy, which can improve symptoms in more than 70% of patients with defecatory disorders 1. However, the standard nursing procedure for digital stimulation remains a crucial component of bowel programs for patients with neurogenic bowel dysfunction.
From the Research
Standard Nursing Procedure for Digital Stimulation
The standard nursing procedure for performing digital stimulation for bowel programs involves several key steps and considerations:
- Digital removal of faeces should be performed by a practitioner competent in this skill 2
- The procedure should be carried out in a safe, effective, and patient-centered manner, promoting privacy and dignity 2
- Digital stimulation is an invasive procedure and should only be carried out when necessary, following a holistic patient assessment 2
Key Considerations
- The use of digital rectal stimulation (DRS) as an intervention in the management of upper motor neuron neurogenic bowels (UMN-NB) in persons with spinal cord injury (SCI) has moderate evidence to support its effectiveness 3
- DRS can be combined with other treatment regimens to manage UMN-NB 3
- The promotion of DRS and education on proper technique should remain an emphasis of education for home management of UMN-NB in persons with SCI 3
Potential Risks and Complications
- Autonomic dysreflexia (AD) is a potential risk associated with digital stimulation and bowel programs in patients with cervical spinal cord injuries 4
- The manual removal of stool can induce AD, and its combined effects with rectal and/or anal sphincter distension and uninhibited rectal contraction may cause a significant increase in systolic blood pressure 4
- Digital rectal stimulation was the most common method for bowel evacuation in patients with spinal cord injury, both before and after bowel program 5
Best Practices
- An effective bowel program can decrease the severity of neurogenic bowel dysfunction and reduce associated gastrointestinal problems in patients with spinal cord injury 5
- The use of standardized, validated tools to evaluate management techniques for UMN-NB is recommended for future research 3
- Bowel care is a fundamental aspect of patient care, and digital removal of faeces should be performed with consideration for the patient's privacy and dignity 2