msmsm

2. Elimination of waste and undigested food in the form of
feces from the colon via the anus.
Facilitated by the enteric nervous system in interaction
with the central nervous system via the sympathetic and
parasympathetic system and neuropeptides.

5. Neurogenic bowel is a general term for a malfunctioning
bowel due to neurological dysfunction or insult resulting
from internal or external trauma, disease or injury.
 Sembelit (Constipation)
 Cirit-Birit (Diarrhoea)
 Faecal incontinence
 Flatus incontinence
 Hemorrhoids
 Abdominal distension/discomfort
TOO HARD…!!!

6.  Spinal cord injury
 Spina bifida
 Traumatic brain injury
 Stroke
 Cerebral palsy
 Parkinson’s Disease

7. ≥ T12 level ≤ L1 level
• Positive anal and bulbo-anal reflex
• Inability to effectively increase intra-
abdominal pressure
• Rectal hyperreactivity
• Loss of rectal sensation
• Loss of voluntary sphincter control
• Hypertonic external anal sphincter
• Anorectal dysynergy
• Fecal impaction in the proximal colon
• Absent anal and bulbo-anal reflex
• No reflex response to increased intra-
abdominal pressure
• Decreased rectal tone
• Reduced anorectal sensation
• Loss of voluntary sphincter control
• Absent external anal sphincter tone
• Rectal fecal impaction

8.  Reduce quality of life
 Burden to carer and time consuming
 Causes distress to patient (bowel accident)
 Patient less socialize at outdoor

9. BOWEL
MANAGEMEN
T

10.  Avoid bowel accident.
 Enable patient to do activities routinely with
fixed schedule bowel regimen.
 Prevent complications (impacted stool and
constipation).

11. - Arrange time ( morning / evening ) based on
patient’s preference.
- Adequate high fiber diet , fruits and water

12. - Put onto left lateral position.
- Abdominal massage
- Drinks plain water to stimulate ‘gastrocolic reflex’ 15-30
minutes prior .

13. A) Suppository
 Eg : Bisacodyl
 Make sure suppository directed towards the wall of
rectum
 Do manual evacuation prior to insertion

14. B) Manual Evacuation
 Use lumbricants and evacuate manually. Break and
remove hard stool if present.
 After remove the feces, may proceed with gentle digital
manual stimulation  stimulate peristalsis and relaxation
of anal sphincter
 Sweep the fingers around the rectal mucosa 15-30
seconds, may repeat 5- 10 minutes until feces removed.
 Used mainly in lower motor neuron spinal cord injury
patient ( eg : Cauda Equina syndrome ).

15. C) Enema
 Fast action
 Simultaneously done with manual evacuation to
ensure complete emptying.
D) Oral medications
 Laxative : liquid paraffin
 Osmotics : Syrup Lactulose
 Stimulant cathartics : T.Bisacodyl (Dulcolax)