Becky Moore, R.N.
This section talks about some of the problems you may have at home with your bowel movements and bladder control. This is a subject that few people discuss openly; it is one that many people don't even think about consciously. But now, after your hospital stay and your treatments, you may be experiencing some discomfort with these functions.
The two main difficulties with the bowels are:
- Constipation—irregular and infrequent bowel movements;
- Diarrhea—unusually frequent bowel movements which are more liquid than usual.
Both problems are uncomfortable, but can be relieved and in many cases, prevented.
Constipation can be caused by lack of activity, or a significant change in diet. It can also be caused by drugs, such as narcotics or chemo-therapeutic drugs. Sometimes constipation occurs because your environment has changed. Perhaps you have less privacy than usual, or you have to use a bedpan.
Here are some simple methods to prevent constipation:
Add to your diet foods that are high in fiber and bulk, such as fresh or dried fruit, vegetables, whole-grain breads and cereals, and bran. Try prune juice or a glass of hot lemon water. Drink lots of fluids of all kinds and be as active as possible .
There are many medications to prevent constipation, such as stool softeners and bulk-form agents. Stool softeners and a stimulating laxative are a must for anyone who takes narcotics regularly. Ask your doctor, nurse, or pharmacist to suggest one that would be right for you. Avoid bulk laxatives if you are taking narcotics; they may lead to severe constipation.
For many people, periodic or even daily use of a suppository is an effective way to stimulate a bowel movement. Glycerine® or Dulcolax® suppositories are two commonly used types. To insert a suppository into the rectum simply wet it with lubricating jelly (K.Y.® or Vaseline®) or even water. With your index finger push it through the anal sphincter (muscle) into the rectum. You may use a rubber glove, finger cote®, or a plastic wrapper or baggie to insert a suppository. Push it in as far as your finger can reach. It takes about 20 minutes for a suppository to stimulate a bowel movement.
Taking a laxative at bedtime will often encourage a morning bowel movement. However, laxatives can be strong medicine, causing abdominal cramping and even diarrhea if used too freely. Ask your doctor or nurse what kind of laxative to use, and how often to use it.
Enemas relieve more severe constipation. An enema introduces liquid into the rectum to stimulate a bowel movement. There are various liquids one can use in giving an enema. They range from the prepared, disposable Fleets® to tap water fed through a rectal tube from a reusable plastic or rubber bag. A Fleets® enema is the easiest kind for you to use by yourself, and is a gentle way to relieve mild constipation. Simply follow the manufacturer's directions. When a more vigorous enema is required, we recommend tap water and table salt (1 tsp. salt to 1 pint water). The water should be a bit warmer than body temperature, about 105°. For this you may need some help. You should lie on your left side with your right leg flexed, and insert the lubricated rectal tube a few inches into the rectum. The container of fluid should be supported about 1 1/2 feet above the buttocks. Now release the clamp on the tube, allowing the water to flow into your rectum by gravity, If you begin to feel cramping, simply clamp the tube for a few minutes before beginning again. Take up to a quart of water in this manner, but stop when you feel you have reached your limit. Hold the liquid in as long as you can; this will usually be no more than a few minutes.
Constipation is the more common problem, but people with cancer can also experience diarrhea as a result of chemotherapy, radiation therapy, sensitivity to certain foods, or emotional stress. Also, although it seems strange, severe constipation can cause diarrhea. (Liquid stool can leak around hard pieces of stool lodged in your rectum when you are constipated.) Your physician will help you determine the cause of your diarrhea and will advise whether any medication is needed.
To relieve the discomfort of diarrhea, the first thing to do is limit yourself to fluids, in order to allow your bowel to rest. Drink plenty of mild liquids, such as apricot nectar, water, and weak tea. They should be either warm or at room temperature. When you are feeling better gradually add foods low in roughage and bulk such as rice, cream of rice, applesauce, mashed potatoes, dry toast, and crackers. As your diarrhea decreases, you may return slowly to your usual diet. It is important to drink plenty of fluids to replace the fluids lost in the diarrhea.
Using a bedpan is a nuisance but it's unavoidable if you can't get out of bed. If you have a metal bedpan, warm it with water before using it. Be sure it is completely dry before attempting to slide it under your body. Powdering the pan helps it to slide in more easily. If a regular bedpan is too large to use, flat "fracture pans" can be obtained.
If you have a continuing problem controlling your urination, measures must be taken to keep your skin dry and clean. For men, a condom-type catheter can be used. To apply it, hold the penis securely in one hand. Place the opening of the condom at the top of the penis and carefully unroll the condom along the shaft of the penis. When it is completely unrolled, take the adhesive foam and wrap it around the condom, being careful that it fits snugly without cutting off circulation. The condom catheter can then be attached to a gravity drainage bag. It can be kept as long as it holds-up to a week.
Sometimes people are sent home from the hospital with a semi-permanent Foley® catheter, which the family helper must learn how to take care of. The main principle to remember is that such a catheter, by going into the bladder becomes a direct line for germs to enter the body. Care must be taken to keep the connections and drainage port free of contamination. This is done simply by being careful not to let anything touch the bag's drainage port when it is exposed to drain the urine. The nurse will show you the correct method before you leave the hospital.
Cleaning the skin and the catheter where it enters the body is very important, too. Twice a day, scrub the area with an antiseptic solution such as Betadine®. Apply a small quantity of antiseptic lubricant such as Betadine Ointment® to the catheter so it does not irritate the skin where it enters the body.