What Goes In Must Come Out

Share:

Facebook
Twitter
Pinterest
LinkedIn

What’s to Come

One of the joys of having a progressive disease is that everything changes. Just as you adjust to one change, something happens and the “fix” you had in place no longer works. As Lynn’s caregiver, I have not found his physician to be particularly helpful in warning me about things to come. If I ask about an issue, he hands me a prescription or makes a referral, however, he rarely provides practical advice. It would be nice if he gave me information about what to expect when a change occurs. Maybe giving home remedies is not an expectation that is practical to have for a doctor, but couldn’t he at least be proactive on warning me about what to expect as challenges? He does not. An example of his failing to prepare us in advance would have to do with when Lynn developed a neurogenic bowel. We were unprepared and had no idea what to do. Therefore, we had to find our own solutions. That being the case, if you use my solutions, consult your doctor first because it is not doctor prescribed, but Steigleder developed.

Now, my waste management problem resolution… 

Initially, the only issues Lynn had with waste management was constipation. Diet managed those issues effectively. He added fiber supplements to smoothies resulting in regular bowel movements (and enough gas to fuel our four vehicles). Over time his GI system adjusted to the added fiber, the gas decreased, and all was well. During the constipation period of his GI story, Lynn worked out regularly and continued to move around independently though with the assistance of a cane or walker as needed.

As his ability to walk became more difficult and his activity level dropped. He also began to take in less food and fluid thus increasing issues with constipation. We tried diet changes again but with minimal relief.

Glycerin Suppositories

One day, I noticed pediatric glycerin suppositories as I walked through the pharmacy. The idea came to me that lubrication might help move “things” along. We tried them and they worked. Since pediatric suppositories are small, they are comfortable to use. Only a small amount of glycerin enters the colon resulting in the need to eliminate a small amount in return.

The greatest drawback to using them is the fact that the Board of Nursing considers the suppositories to be medication. I primarily hire nursing assistants to care for Lynn if I am not home. Nursing assistants cannot give medications. Therefore, some nursing assistants do not want to work for me since I need them to give suppositories to help start a bowel movement. Anybody, including a nursing assistant, can pick them up a suppository without a prescription in the drugstore and can use them. A nursing assistant, by law, cannot give a suppository because it is classified as a medication. Ridiculous, right?

Over time, our greatest challenge in any day is helping Lynn have a bowel movement. We often pray for a successful trip to the bathroom, no joke. When the event goes smoothly, I have been known to do a happy dance in celebration.

Weak Abdominal Muscles

We make life decisions around the toilet now. Lynn has limited abdominal muscle power to push. Therefore, I must help. Though I use suppositories and enemas to lubricate and expand the colon, I must use my finger to stimulate the opening in the rectum for stool evacuation. Then, I must manually push on his abdomen to help force the movement of the fecal matter down the intestine to the colon to empty it. This entire process is very physical and awkward. I have a gait belt around his waist to help me hold on to so that I can control his upper body as I lean him forward to insert the suppository or enema. We also installed side rails beside the toilet seat without rails could not keep him from falling over, so, he sits between handrails to keep him from falling to either side. He is very secure. Plus, we installed. taller toilet so his legs and feet sit comfortably on the floor for stability.  I position his legs so that support him like a tripod as he leans forward. It works but it can be a little uncomfortable for both of us.

Every morning we have our regular routine all aimed toward the “bathroom event.”  He gets up, has hot tea (heat and caffeine to stimulate the bowels), exercises (to get the blood flowing to the bowels), takes his medication (just because he must), gets undressed and rolls onto the lift to go to the toilet and off we go….  That time could last from 15-30 minutes or more and it really wears him (and me) out. We usually listen to the Bible while we are performing the bowel preparation a good distraction, so it does not feel like we are wasting time. Oh, and he takes Polyethylene Glycol (Miralax or something similar) every night to keep his stool soft enough to easily move.

Here is our toilet routine.

This is gross so do not read it if you have a weak stomach.

Step 1 – Priming – Glove up and insert one pediatric glycerin suppository and wait for sensation that it is working.

Step 2 –Glove up, lubricate gloved finger or wipe with baby oil – stimulate opening and insert finger. Rotate finger till rectum opens and fecal material begins to evacuate.

Step 3 –Glove up, lubricate gloved finger or wipe with baby oil check to see if anything remains in colon; if so, put on clean glove and insert anther suppository

Step 4 – allow the second suppository to work; when ready, put on glove, lubricate gloved finger or wipe with baby oil, stimulate opening and insert finger. Rotate finger till rectum opens and fecal material begins to evacuate.

Step 5 – Glove up – lubricate gloved finger or wipe with baby oil, check to see if anything remains in colon, if so, try pediatric enema this time

Step 6, Glove up, insert pediatric enema.

Step 7, Glove up, lubricate gloved finger or wipe with baby oil, stimulate opening and insert finger. Rotate finger till rectum opens and fecal material begins to evacuate.  Usually by now it is empty.  If not, repeat your finger after waiting a while. I do not usually put anything else in after an enema; I just dress him and come back later in the day to repeat the process.

Step 8 Clean him up.

I use flushable wipes to clean up and I also cover my gloved finger with a flushable wipe which I lubricate with baby oil often. Only use flushable wipes; not diaper wipes or you will stop up your toilet and septic system.

Bowel Issues are a Problem

Bowel issues are a real problem. We cannot go out in public if there is a question of diarrhea or the need to go to the toilet in public; those baby changing tables just do not hold adults very well and picking them up off the floor after changing them just isn’t a good option.  Also, have you noticed that doctor’s offices avoid checking their bottoms or doing any procedures where they might have to put them on the table to check them out? That annoys me. I understand the difficulty but think of what they might miss. Buttock wounds are so common for people who have limited mobility or incontinence issues that checking “down there” should be a priority; not something they avoid.

Anyway, this is a delicate subject that I have hesitated to discuss but one of my followers asked me to share what we did so here it is. I hope it has been helpful to those of you who are in the same situation and for the rest, hope you never have to “go” here.

This article originally appeared on Multiplesclerosis.Net by Health-Union, LLC and has been reposted with permission.

1 thought on “What Goes In Must Come Out”

Leave a Comment

Your email address will not be published. Required fields are marked *

Healthcare to homecare provides information and resources to help new and experienced caregivers take on the role of healthcare provider at home.
Healthcare to homecare provides information and resources to help new and experienced caregivers take on the role of healthcare provider at home.
Caregivers of special needs children face many challenges and overwhelming emotions. Loss of dreams, fear of the future, and much more. They need someone who understands and doesn’t judge; someone who’s been there and gets it.
Caregivers of special needs children face many challenges and overwhelming emotions. Loss of dreams, fear of the future, and much more. They need someone who understands and doesn’t judge; someone who’s been there and gets it.