Quiz - Bowel Management

Question 1

autorhythmicity

Answer 1

Rhythmic smooth muscle contraction without nervous input

nervous input is required for controlled coordination

Question 2

Describe the intrinsic nervous system of the GI tract.

Answer 2

Extends from esophagus to anus; can act independent of the nervous system.

(nervous input is required for controlled coordination)

Question 3

Which two reflexes are part of the intrinsic nervous system?

Answer 3

Gastrocolic reflex and peristaltic reflex

Question 4

What is the gastrocolic reflex?

Answer 4

Food or warm fluid entering the stomach causes reflexive evacuation of the colon (response is strongest after 1st meal of the day)

Question 5

What is the peristaltic reflex?

Answer 5

Distention initiates reflexive contraction propelling food mass down

Question 6

What is the role of the autonomic system?

Answer 6

Coordinates the bowel with the rest of the body

Question 7

Which two innervation systems make up. the autonomic system?

Answer 7

Sympathetic and parasympathetic innervation

Question 8

sympathetic innervation

Answer 8

Arises from T8-L2 and inhibits digestive functions

Question 9

parasympathetic innervation

Answer 9

Cranial and sacral (S2-4) innervation that stimulates digestive functions

Question 10

Somatic nervous system

Answer 10

Voluntary control of external anal sphincter & pelvic floor m.

Question 11

Where is the somatic nervous system innervated?

Answer 11

S2-4

Question 12

What are the two reflexes that are involved in defecation?

Answer 12

Intrinsic defecation reflex and the parasympathetic defecation reflex

Question 13

Intrinsic defecation reflex

Answer 13

Mediated by the intrinsic system that when elicited by feces entering the rectum causes relaxation of the internal sphincter and increased peristalsis in the descending colon, sigmoid, and rectum

*Not usually strong enough to cause defecation

Question 14

Parasympathetic defecation reflex

Answer 14

Required for normal defecation and is activated by a sacral spinal reflex

Once activated by filling of the rectum, it causes relaxation of the internal anal sphincter and an intensification of peristalsis in the descending colon, sigmoid, and rectum

Question 15

What is the pathway for defecation

Answer 15

Internal anal sphincter is active at rest
–>
Feces enters the rectum and the internal sphincter relaxes

At the same time, the external anal sphincter contracts to prevent unwanted defecation (not a good time, hold it!) This contraction, caused by a sacral cord reflex, is brief.
–>
Decide whether to continue or discontinue the contraction
–>
Voluntary control is dependent on sensory input and motor output (between S2-4 and cerebral cortex)
–>
Defecation involves voluntary relaxation of the external anal sphincter and pelvic floor m., close the glottis, contract the abdominals
–>
Stimulates the defecation reflex

Question 16

Bowel function after SCI

Answer 16

Acute SCI–> spinal shock 6-12 weeks –> areflexive bowel –> paralytic ileus

(risk for blockage, must be NPO until bowels cleared)

Question 17

What is paralytic ileus?

Answer 17

Build up of pressure in the small intestine due to loss of peristalsis

Question 18

What are the symptoms of paralytic ileus?

Answer 18

Absence of normal bowel sounds causing visible swelling of the abdomen and possible vomiting (can force the stomach contents up into the airways)

Question 19

What are the treatment options for paralytic ileus?

Answer 19

Nasogastric suction, NPO status (nothing by mouth), IV fluids and electrolytes

Question 20

For long-term bowl function after spinal cord injury, which of the following is/are intact: autorhythmicity, intrinsic system, autonomic system and somatic system?

Answer 20

Autorhythmicity and intrinsic system = YES
Somatic system = NO
Autonomic system = sometimes

Question 21

Describe reflexive long-term bowel function after SCI.

Answer 21

S2-4 reflex arc intact, typically SCI above T12

Defecation occurs normally via reflexes

No volitional control over timing

May not fully empty

Question 22

Describe areflexive long-term bowel function after SCI.

Answer 22

S2-4 reflex arc impaired, typically SCI below T12

Without the stronger parasympathetic defecation reflex, the bowel will not empty reflexively

High risk for feces to become impacted in the rectum

Incontinence when stool passes unhindered from the rectum

Question 23

What is the key factor that determines bowel control?

Answer 23

The integrity of the sacral arc reflexes

Question 24

GOALS FOR BOWEL MANAGEMENT

Answer 24

To condition the bowel to empty at scheduled intervals

Prevent constipation and impaction

Prevent AD

Minimize incontinence

Question 25

Describe bowel management for a reflexive bowel.

Answer 25

Accidents via reflexes

Manual removal, suppository, digit stimulation

Want stool to be formed and soft

Question 26

Describe bowel management for an areflexive bowel.

Answer 26

Impaction or accidents via mechanical means

Suppository sometimes, manual removal, abdominal contraction, laxative sometimes

Want stool firm but not hard

Question 27

What are the indications and advantages for colostomy or ileostomy?

Answer 27

Indications: severe constipation, incontinent, perianal pressure ulcers

Advantages: less manual dexterity required, decreased time for care, eliminates incontinence

Question 28

How is a colostomy or an ileostomy accessed?

Answer 28

Via a stoma that needs to be kept clean and dry

Question 29

What are the two options for FES?

Answer 29

Surgically implanted electrodes or surface electrodes on abdominal muscles

Question 30

What are some tips for a successful bowel program?

Answer 30

1. Perform bowel program at the same time each day
2. Large meal promotes movement via gastrocolic reflex
3. Physical activity promotes bowel motility
4. Use gravity and or straining if possible
5. Lie on LEFT side (no bedpan) or sit up (preferable)
6. Massage abdomen in direction of large intestine
7. Good stool consistency via adequate fluid intake, high fiber diet, stool softeners, laxatives, meds

Question 31

What do OT’s have to do with bowel care?

Answer 31

Empathy, timing/schedule formation, positioning, transitional movements/transfers, manipulation skills, equipment recs, home mods, patient and caregiver education, emphasize importance of sin care

Question 32

What are some pieces of adaptive equipment that can be used for toilet transfers?

Answer 32

Drop-arm BSC (padded = better), digital stimulation commode, transfer board, shower commode w/c

Question 33

What are some assistive devices for hand function during bowel program?

Answer 33

Digital stimulator with u-cuff, suppository inserter with u-cuff

Question 34

Who else can have neurogenic bladder/bowel issues?

Answer 34

Alzheimer’s, diabetic neuropathy, MS, neuropathy, nervous system tumor, stroke recovery