# Presentation: 710679

## DIGITAL STIMULATION

- Boston VA Healthcare System
- Kelly D. Skinner, RN, SCI Clinical Specialist
- James T. Daniel, RN, BSN, SCI Homecare

## Digital Stimulation

- _PURPOSE_:
- To stimulate peristalsis and aid in defecation for the individual with a neurogenic bowel.

## What is a neurogenic bowel?

-    A **neurogenic bowel** is a condition that happens when the brain and nervous system cannot control bowel functions after a Spinal Cord Injury, whether from trauma or a medical condition like MS or ALS.  Some neurogenic bowel conditions are best-managed by **digital stimulation.**

## ESSENTIAL STEPS IN PROCEDURE

- 1.   Wash hands!
- 2.   Explain procedure.
- 3.  If in bed, turn individual on left side, if possible and place incontinent pads under buttocks.
- 4.  If the individual can be up in a chair, place on a well-padded commode chair and place over the toilet.

- 1.  Hand washing is considered the single most important procedure in preventing cross-contamination.
- 2.  To alleviate anxiety and elicit cooperation and begin teaching.
- 3.  Place pillow to back and between knees to assist in keeping in position.
- 4.  The force of gravity will aid in moving the intestinal contents.

_**KEY POINTS **_

## 5.  Insert a gloved, lubricated finger gently through the anal sphincter.

6.  Move finger in a circular motion slowly and gently.

7.  Make this circular motion for 30 seconds or longer until stool is felt against the finger and the sphincter muscles begin to relax.  Wait several minutes; repeat this step until no stool is felt in the rectum.  

- 6.  Move finger in a circular motion slowly and gently.
- 7.  Make this circular motion for 30 seconds or longer until stool is felt against the finger and the sphincter muscles begin to relax.  Wait several minutes; repeat this step until no stool is felt in the rectum.

- 5.  Be _gentle_ and use **plenty** of lubricant.
- 6.  Stimulates rectal contraction.
- 7.  The length of time varies depending on how tight the sphincter muscles are, or how spastic the individual is, whether there is stool present in the rectum, and the individual pattern of the patient.

_**ESSENTIAL STEPS IN PROCEDURE**_

_**KEY POINTS **_

## 8.  Wait 3-4 minutes and recheck/stimulate again if stool is in vault.

9.  The individual may be instructed to hold his/her breath and push or cough. 

10. Cleanse as indicated.

- 9.  The individual may be instructed to hold his/her breath and push or cough.
- 10. Cleanse as indicated.

- 8.  A mucous return and a closed internal sphincter signify completion of the procedure.
- 9.  Pressure in the rectum can be raised by use of these measures.  Massaging with the hands over the lower abdomen may also help evacuate the bowel.

_**ESSENTIAL STEPS IN PROCEDURE**_

_**KEY POINTS **_

## 
11.  Position patient for comfort.

12.  Remove and discard soiled         supplies & equipment.

13.  Dispose of equipment in                     appropriate waste receptacle.  

- 11.  Position patient for comfort.
- 12.  Remove and discard soiled         supplies & equipment.
- 13.  Dispose of equipment in                     appropriate waste receptacle.

- 11.
- 13.  Waste material contaminated with feces may be disposed of in regular trash receptacle, however, if _blood_ is present, material must be disposed of as infectious waste.

_**ESSENTIAL STEPS IN PROCEDURE**_

_**KEY POINTS**_

## 14.  Wash hands!

Record procedure and results on Bowel Care Record.

16.  Report any abnormalities or problems to nurse or doctor as indicated, and/or in Progress Notes, as appropriate.

- Record procedure and results on Bowel Care Record.
- 16.  Report any abnormalities or problems to nurse or doctor as indicated, and/or in Progress Notes, as appropriate.

-       14.  Hand washing is considered the single most important  procedure in preventing cross-contamination.
-        15.
-        16.

_**ESSENTIAL STEPS IN PROCEDURE**_

_**KEY POINTS**_

## The End!

- Bowel Tx’s