G. BOWELS*

G. BOWELS AND SHOWERING*2023 update

My advice

If you dont want to spend your life waiting for staff, organising staff, or putting big demands on family and friends learn to do it yourself.

Find a routine that works and stick to it religiously even when life is not going well. Your bowels do not forgive, they make no allowances, they just react to what you eat.

For me – the solution for many years has been Normacol, Oranges, and a technique to give myself a Bisalax enema. That technique has changed several times and you may find another solution.

Bowel care was the most difficult thing to become independent in (apart from toenail clipping), and its not perfect. Accidents do happen occasionally.

I shower in the commode chair after the bowel routine. It requires a wheelchair accessible (roll-in) shower and a hand shower. I always alter the bathrooms where I live (see houses) so there is no shower cubicle its just an open space with a toilet, shower, hand basin and washing machine.

This bathroom set up is critical as all my techniques result in a lot of poo on the floor instead of, or in addition to, in the toilet. This means the bathroom must be set up so it can be easily hosed down the floor drain during the shower process.

This works well as long as I take Normacol 12 hours before hand and I eat one orange a day. The Normacol and the orange provide enough fibre to allow the enema to work. Also I generally eat a lot of vegetables and do some exercise. If I let any of these elements slip for three days I have bowel accidents and life becomes difficult and dysfunctional.

For a long time I went to the toilet and shower every second morning, it takes about and hour and a half. This allowed me to work and function fairly normally in the world, although perhaps only because I organised myself to live very close to my work and had work that allowed late styarts.

Since 2022 I have changed to 2 mornings in a row then skip the third morning. I retired in 2020 so this works fine. I’m not sure it would be ok if I was still working.

My enema technique – prior too 2018

For 30 years I was independent in bowel care because I used a tenodesis splint to give myself an enema every second day. I did this whilst I’m sitting in a commode chair. I put the splint on my left hand, put the enema between the thumb and forefinger, hooked my right arm around the push handle of the commode, leant sideways and reached under my backside with my left hand, inserted the enema, and then used my wrist extension to get the splint to squeeze the enema.

My tenodesis splint is the gadget I used to squeeze an enema. I can imagine getting a better gadget made. I tried a few times but didn’t get anywhere, so I stopped because the splint worked for me, but I’m sure something better could be designed.

There are commodes out there that are designed for people to reach under in the way I do. They definitely make the whole task easier. They have a cut out on the edge of the seat on the side you reach under. I didn’t know about them for a long time so didn’t get one until 2018.

Pictures:

Bathroom

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Commode with left hand cut out

splint, hand with the splint, splint ready to squeeze enema

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normacol, oranges, enema

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My enema technique – 2018 to 2022

In 2018 I had nerve transfer surgery on both arms. To find out what that is go here. It is intended to improve hand function but in my case it failed, and afterward I was no longer able to use the tenedesis splint to insert the enema. T his meant I needed carers on bowel care days. I found them very unreliable and as result my working life became unmanageable.

After a lot of searching I found trans-anal irrigation. Unfortunately none of the commercially available gadgets seemed suitable for independent operation by me as a C6 quad, however I found I could make one that works for me.

I made the device from what is called an ear syringe and the cut off end of an overnight drainage bag.

First I squeeze the enema into a small plastic vial and put some lubricant into a second vial.

Second I use my mouth to squeeze the balloon flat, then fill the balloon and the tube with warm water via suction by putting the end of the tube in water and opening my mouth to allow the balloon to swell.

Third I use my mouth to squeeze out a little of the warm water so I can suck the enema up into the tube.

Fourth, I put the end of the tube between my first two fingers and use elastic bands to hold it in place, and put the balloon in my mouth.

Fifth I put some lubricant on the end of the tube and then reach underneath and insert the end of the tube, and then squeeze the balloon with my mouth to inject the enema and the water.

The suction device and two vials.

The end of the tube between the first two fingers of my left hand, held in place by elastic bands

My enema technique – from April 2023

In September 2022 I had a stroke due to autonomic dysreflexia from a blocked catheter. I mostly recovered but was left with a further reduction in sensation, including substantial loss of proprioception, in my left hand. As a result I was no longer able to use my left hand to insert my homemade trans-anal device. I tried to do it with my right but could not because I cannot pronate my right wrist. The technique I had been using with my left requires pronation.

As a result I needed carers on bowel care days. Thankfully this time the carers were great but it was not at all what I wanted.

So I kept searching for a new method and after a lot of trial and error I found a way to do it with my right hand. 

I put the end of the tube between my thumb and first finger on my right hand and use elastic bands to hold it in place. My right hand still has the amount of sensation and proprioception I am used to, so this means I can insert the tube without pronation. Then I squeeze the balloon in my mouth to inject the enema and the water as before.

I also modified my commode to make it a right hand cut out rather than a left hand cut out.

The end of the tube between my right thumb and first finger, held in place by elastic bands.

CLICK HERE to see a guy who does it in a very different way from me.

I have also met another C6 who got a gadget made to squeeze an enema. He later changed to just relying on the shower and the water and eating right. He says this works for him and as a result he does not need unreliable carers.

Here’s what the experts say

Basically they say it cant be done

CLICK HERE for more info on tenodesis splints

CLICK HERE for more info on the commode with cut outs

Rule number 7 – You are what you eat.

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