GENERAL HINTS

Use some kind of fiber at least once a day. Breakfast is the best time. Use something like regular oatmeal (not quick cook type) bran cereals or bran, oat, or whole grain muffins. Whole grain breads are better than white breads. Use apple juice or cider or prune juice at least once a day. Some folks need it twice. Apple cider that still has the pureed pulp in it is good because it contains the fiber of the fruit. If it is used hot and spiced with stick cinnamon and whole cloves, it tastes wonderful and gives you a hot beverage too.

I know several people that use two tablespoons of salad oil or olive oil daily. Some use it on a salad which adds roughage to the diet. But it can be taken straight from the spoon. Do not use mineral oil.

With breakfast, drink some sort of hot beverage. Immediately after breakfast and completed hot beverage, get up and try to use the commode on a daily basis. Even if there is no success, this tries to train the bowel and brain that this is the time to work. (The getting up part may have to be given up after a while if it doesn't work but give it at least two or three months to retrain. This is sort of like training a little one how to make things work right. You are retraining your body.)

Drink plenty of water BESIDES any other beverage you use during the day. At least two quarts of plain water is necessary to aid the bladder and bowel to eliminate all the body wastes on a daily basis. This is scientific fact. (For folks with MS bladder problems, this may also necessitate changes in a bladder plan.)

Use a stool softener such as Colace once or twice a day. This has to be adjusted according to the need of the person. Also use a product like Metamucil daily. There are now several of these on the market including store brands (of large pharmacies) which are usually less expensive but just as effective. Discuss which products would be best for you with your physician. You might also want to talk to your physician about working with a rehab nurse experienced in bowel program development.

BOWEL PROGRAM
(This program was given to me by a friend who is quadriplegic and has consulted with a nurse practitioner who is an educator in such matters. You may want to ask your physician to recommend one to make a specific plan for you according to your condition and specific problem.)

On the second or third day of having no bowel movement, take a laxative at bedtime. It is normal for some people to have a bowel movement as seldom as every three days. It is essential that you follow the pattern that your body had before the constipation or loss of bowel control occured. Senokot is recommended. Milk of Magnesia 25cc and Cascara 5cc is a little harsher but sometimes necessary.

After breakfast and trying the method above in trying to use the commode, use a Dulcolax Suppository if there has been no success. This usually takes 45 minutes to an hour and a half to work. This is an irritant to the bowel and may cause a sudden need to move the bowels.

If this does not work, use a Fleets Enema of the oil type. This gives extra stimulation but also lubricates the bowel. This must be given while the person is laying on the left side so the fluid can follow the natural curve of the bowel and not have to fight gravity. Be sure to pad the bed with something nonpermiable because there may be leakage of the oil or a sudden need to defecate.

If the Fleets does not work within an hour or so, use an enema called CEO2 (sp). Keep the bed padded. Also give this enema with the person laying on the left side. You may want a bedside commode handy.

Only if these methods don't work, and she sometimes uses a warm water enema in addition, do a manual removal of feces. This can be very traumatic to the lower bowel and rectal tissue and should be avoided if possible. The caregiver should be trained by a nurse before attempting manual removal of feces. Sometimes only a part of this method needs to be used and sometimes all of it. I have used all of the above on patients but the CEO2. That particular enema was not on the market (or I was unaware of it) when I was practicing nursing on a daily basis.

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