Bowel care is an extremely important aspect of living a healthy lifestyle after sustaining a spinal cord injury. The Shepherd Center provides information on how to perform different bowel program techniques for those who are newly injured. All videos are courtesy of our Model Systems Knowledge Translation Center partners. Visit MSKTC for more resources on many more spinal cord injury-related topics.
Digital Stimulation
Digital Stimulation involves inserting a finger or “dil stick” inside the rectum and moving it in a circular motion. This circular motion stimulates the bowel reflex, and the rectal muscles open, allowing the stool to leave the body. While a person may feel pressure with this technique, no pain should be felt. Therefore, this technique should not be done on those who feel pain sensation in their rectal area. Digital Stimulation should be done at the same time every day or every other day (depending on the individual) to stay on a schedule and avoid accidents.
How To Perform Digital Stimulation
First, gather all of the supplies. Supplies include: gloves, “dil stick” (optional) lubricant, soap and water with a washcloth, toilet paper and underpads (if done in bed), plastic bag to throw away waste, and/or raised toilet seat, shower or commode chair (if done in the bathroom.) Next, make sure to wash your hands. Place all of your supplies on a towel with easy access.
Move your body in the correct position. The Shepherd Center advises you to lie on your left side with your knees flexed (right leg over left leg) and place a disposable pad under the buttocks. Transfer to the appropriate bowel equipment if digital stimulation is performed in the bathroom.
Once in the correct position, put gloves on both hands or place a dil stick in your hand. Make sure to lubricate your finger or dil stick and insert it into the rectum past the rectum. Gently move your finger or dil stick in a circular motion. Remove or move your finger or dil stick to one side when the stool begins to empty.
Perform digital stimulation for at least 20 minutes if no stool is produced. If the stool does start to empty, perform digital stimulation for as long as the stool is coming out and for five additional minutes after the stool stops coming out. Wipe the buttocks and rectal area with toilet paper when digital stimulation is complete. Wash the area with soap and water and dry it with a towel.
The Shepherd Center warns that digital stimulation can cause autonomic dysreflexia for persons with spinal cord injuries at level T6 and above. Symptoms include increased blood pressure, headache, blotchy skin, sweating, and stuffy nose. If you experience any of these symptoms during digital stimulation, stop immediately, sit up, and insert a local numbing agent.
Manual Evacuation And Rectal Suppositories
Manual evacuation is done for people who have a non-reflex bowel. For manual evacuation, the stool is emptied by inserting a finger into the rectum and removing it. Rectal suppositories are used in manual evacuation and for people who cannot tolerate digital stimulation. However, they are sometimes used in digital stimulation as well. Suppositories should be given at the same time daily or every other day, depending on the person. Most people take them at night because it can take eight to 15 hours for the suppository to work.
How To Perform Manual Evacuation And Rectal Suppositories
The first step in this technique is to gather your supplies, including gloves, lubricant, soap and water, washcloth and towel, toilet paper, underpads (if done in bed), plastic bag to throw away waste, and/or raised toilet seat, shower or commode chair. Be sure to wash your hands. The next step is to prepare all supplies and place towels. Position yourself on the shower or commode chair. If you prefer to be in bed, lie on your left side with an underpad underneath your buttocks. It may be helpful to prop yourself up with an elbow or padding.
Put gloves on both hands and place lubricant on your finger. Do a rectal clearing before putting in the suppository. Place a small amount of lubricant on the suppository and insert it into the rectum, but do not push it into the stool. The suppository should stay in place for at least thirty minutes.
If you cannot transfer to a commode chair, stay on your left side and do a rectal clearing onto the underpad. Clean buttocks and rectal area with toilet paper when stool stops coming out. Wash the area with soap and water using a washcloth and dry with a towel. Throw away all waste, and remember to wash your hands.
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This AbleThrive article was first published on March 16, 2018. It was updated on February 6, 2025, to provide video resources on bowel programs.