Equipment and assistive technology
Adaptive devices
People with SCI who have functional impairment of the upper limbs may find it difficult to manage tasks required for bowel care (e.g. inserting enemas or suppositories).
Adaptive devices listed below may help patients achieve independence with inserting enemas or suppositories during bowel care.
There are commercially available devices with modified hand pieces which allow a person with reduced hand function to insert their own suppository.
Suppository insertion is done while the person is lying in bed, as this allows time for the suppository to melt and start working.
To use the device, the person puts the modified hand piece over their hand then puts the suppository in the hollow plastic tube.
The person would then need to reach around, locate the anus, and insert the suppository.
The device has a spring on the stem and when light pressure is applied, the suppository is pushed out.
It's important to know the length of time between the insertion of the suppository and the subsequent bowel movement to make sure the person allows enough time for a safe and unhurried transfer to the toilet or commode.
Enema inserters are not commercially available but can be manufactured.
Enema inserters, like suppository inserters, use a modified hand piece.
Due to their design, enema inserters require a reasonable amount of pressure to squeeze and empty the fluid.
To use the device, the person puts the enema into the holder then places a cap over top of the enema.
A rubber band prevents the cap from falling off and helps the cap to slide up and down when the enema is inserted, and the fluid squeezed out.
A therapist and/or nurse can conduct an assessment to review the positioning required and the process for performing independent bowel care.
When conducting this assessment, the therapist will consider the following:
- What type of product (suppository or enema) is the person using?
- Can the person access the product?
- Can they pick it up?
- Can they peel open the packaging or access some that have already been removed from the wrapper? Some people can tear the packaging open by using their teeth. Be mindful that the suppositories may soften in warm environments if they have already been unwrapped for some length of time.
- Can they remove the tip/cover from the enema? If it is pre-opened, the fluid could spill from the enema. Storage once open is important.
- What is the person’s balance, positioning and reach like?
- Is the reach better on bed or on the mobile shower commode? If the person is using a commode, the preferred product to use would be an enema as suppositories need time to melt to be effective and could also be expelled intact in a sitting position.
- Will the person need to use mirrors to help with the task? Can this independently be set-up? Would a mounted mirror on a wall or door make the task easier instead of a smaller standing mirror placed on the bed?
- Is the bed/mattress a suitable surface or combination to allow the task to be completed?
- Check firmness of the mattress and independence with bed mobility
- Does the bed size allow enough space to move and complete the task?
- Is it possible to adjust the angle of these devices to cater for their hand function and position?
- Does the strap or mechanism of holding the suppository or enema need adapting due to the degree of hand function impairment?
- Does the person receive any care supports who could assist if needed? This could allow for the ability to attend to preparation for the routine, assist with some of the task or allow supervision or support until the person can master the task independently.
You can contact a QSCIS occupational therapist for more information and support as needed.