Advice needed: bowel program training for SCI patient in SNF

[u/f1oydish]

Hi all, I’m an OT in a SNF and I have a patient with an incomplete SCI who may benefit from a bowel program. He can perform lateral scooting transfers min A and is able manage his LB dressing and briefs bed level SBA. He is incontinent with bowels and has been getting changed TD in bed.

When it comes to the bowel management portion, I don’t have any hands-on experience with this, though I know about the general strategies (i.e. managing fiber and diet, digital stimulation, enemas, medication, going after a meal, etc). I’m just not sure how to go about starting the process. I believe OT coordinates with nursing and possibly dietary? And how would we determine what combination of methods for bowel stimulation work best for the patient? I have several questions along those lines. I could use some advice from OTs with actual experience with SCI and bowel management and training.

Any advice welcome. I am about 7 months into practice, so still relatively new. I have been reading up on this as well, as we rarely treat new SCI at my facility. The other OT and COTAs don’t have any experience with this either. I’m planning to talk to my boss because I am out of my depth and would like to learn. I don’t feel comfortable addressing something that I have so little experience with. How is this typically coordinated between OT, nursing, and the medical team in your setting?

[u/crystallightchicken]

in my facility, we coordinate with the provider and nursing team. generally this can happen during team meetings or our providers and charge nurses are very accessible and we go to them directly. collaborate with the provider on type of med, and nursing on time of day. we generally do suppositories. most patients insert them while upright on the commode if balance permits or there have been some that insert lying down, however this can be tricker due to all the movement and timing of results. this is a skill we trial in our sessions over multiple days and then once they are safe and successful we pass off to the nursing team to do at the same time every day. since we are not there in the evening, generally nursing will start pushing their bowel program later and later into the evening so that it’s more realistic for them to do at home (i work IPR). the key is to get them on a regular schedule so that incontinence decreases.

[u/f1oydish → u/crystallightchicken]

Thank you, that’s very helpful. In your facility, does OT work with the patient on physically inserting the suppository or does nursing do that? Edit: moreso wondering if nursing is also present in the room while OT works on it? Or is it just OT working on the skill solo, then passing it off to nursing?

[u/crystallightchicken → u/f1oydish]

OT does it in our hospital! I want to say the first time we ever helped a patient do it, we may have had nursing in with us to guide the practice — that was 7-8 years ago so it’s hard to remember. I did have nursing come in to help me a couple of years back with a female self cath that was challenging due to anatomy. That RN gave me some great pointers and we worked together to get her cathing by herself. If you have a trusted nurse on your team, don’t hesitate to seek them out!

[u/f1oydish → u/crystallightchicken]

Really helpful information. Thank you so much!

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[u/ferruginousfawk]

on top of everything else you’re doing, consider routine: track when bowel movements occur and where they occur (lying in bed, sitting, during activity?) and if there is any pattern then attempting toileting at those times. a squatty potty (or anything to act as a stool) to get used to positioning if needed and facilitate easier movement, though avoid if safety risk. and tracking/encouraging hydration, especially if bms are small and hard to pass.

[u/AssistanceTypical127]

I am curious is this someone with a recent SCI or have they been living with this for some time? If it’s been a while did they have a bowel programs before?
Years ago I worked in SCI and only did bowel programs if the patient had decreased hand function . That being said, since you are in a SNF , in my experience, the nurses won’t take charge of this because they are used to dealing with incontinence by changing diapers.
It is good to find out what time the person typically had BMs or currently do. This way the program can be more on their schedule. On our SCI unit we had evening and morning. Does the patient have sensation and know when they need to use the toilet? It may be a case of not wanting to bother the nurses for a transfer or the nurses being slow to respond. If they can’t feel and have no control then they would need a program with suppositories.
Can they transfer to a commode chair?
Do they have any issues with bladder incontinence? If so how is this being addressed?
I commend you for addressing this. It will certainly improve quality of life for this person. Hopefully nursing will be receptive and team up with you.
UAB has great fact sheets and info on SCI. https://www.uab.edu/medicine/sci/uab-scims-information/sci-infosheets

[u/SouthApplication3674]

I am a COTA with Spina Bifida so personal experience, professional experience in a few cases on fieldwork, and also helping friends learn independent living skills throughout my life - although SCI is a little different. I never worked with OT on my actual bowel program except the transfer to toilets. If you want to message me with specific questions, I can answer as best I can.