Bowels

• Most patients have problems moving the bowel and are also constipated; usually treatment is required for both problems. Many patients have alternating constipation and diarrhoea.  The colon gradually fills up and this is followed by functional diarrhoea as the colon self cleanses.  A regular laxative is required to even out the bowel pattern.

• Some patients are able to move their bowels normally with acceptable control.  Some need laxatives or dietary manipulation.

• Patients with a reflex bowel usually use stimulant suppositories or mini enemas.  Typically two mini enemas are used on alternate days.  Senna is often used the night before.  They need a stool of normal to soft consistency.

• Patients with an areflexic bowel usually need to do manual evacuation (ME), typically once or twice a day.  They need a firm stool to maintain continence and permit ME.

• A rectal washout system e.g. Peristeen can be used.   An ACE (antegrade continence enema) procedure can be performed to enable colonic irrigation.   A colostomy is another option.

• Movicol is a faecal softener,  Senna is a colonic stimulant.   It is recommended that the consistency of the stool is adjusted with Movicol initially if necessary.  A typical starting dose is half a sachet a day.  The dose should be increased no more often than weekly to avoid accidents.  Senna can be used in addition, again increasing the dose slowly.  The dose of Movicol may need to be reduced.

• A large dose of Movicol (6-8 sachets) or Picolax (2 sachets) will cause diarrhoea and can be used for a bowel clear out.

• Bowel management is improved by trial and error with the patient being in the best position to vary their treatment.