- 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
- Some patients are able to move their
bowels normally with acceptable control. Some need laxatives or dietary
- 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
- Bowel management is improved by trial
and error with the patient being in the best position to vary their