{"id":486,"date":"2020-07-03T15:15:40","date_gmt":"2020-07-03T14:15:40","guid":{"rendered":"http:\/\/www.rollingwith.me\/wordpress\/?p=486"},"modified":"2020-08-24T11:06:47","modified_gmt":"2020-08-24T10:06:47","slug":"three-out-of-four-pees","status":"publish","type":"post","link":"http:\/\/www.rollingwith.me\/wordpress\/three-out-of-four-pees\/","title":{"rendered":"The Three P’s… Poo"},"content":{"rendered":"

When I managed a unit that supported people who had dementia, I used to tell my staff that if someone\u2019s behaviour suddenly changed and [for example] they became aggressive, they should always consider the \u2018three P\u2019s<\/em>\u2018 first:<\/p>\n

P<\/strong>iss (urine infection?)<\/p>\n

P<\/strong>oo (constipation?)<\/p>\n

P<\/strong>ain (generally)<\/p>\n

\u2026as these can all impact upon a person\u2019s mental state, in particular people with dementia who are unable to articulate how they are feeling. If staff could rule these out first, they could often make huge difference to the quality of a person\u2019s life, both physically & mentally.<\/p>\n

I\u2019ve not become aggressive, but in this and the next two blogs, I will be very personally & intimately discussing\u2026<\/p>\n

Piss<\/strong>, Poo<\/strong> & Pain<\/strong><\/em><\/span>.<\/h1>\n

If talking about these subjects already has you crying \u201ctoo much information<\/em>\u201d then you really need to skip this entry altogether and the following two blogs (one for each \u2018P\u2019<\/em>) and return when I get around to writing about normal stuff again.<\/p>\n

In the style of the BBC News, before \u2018Match of the Day<\/strong>\u2018<\/em>,<\/p>\n

\u2018if you don\u2019t want to know the result, look away now<\/em>\u2018.<\/p>\n

Click here for some kittens, see you soon!<\/a><\/h3>\n
\n

Right, now they\u2019ve gone\u2026<\/p>\n

So you\u2019ve\u00a0acquired a disability? <\/i><\/h3>\n

Well, as they say, \u2018shit happens\u2019!<\/i><\/h3>\n

Except if you have a spinal injury, in which case, shit most certainly doesn\u2019t happen <\/em><\/span><\/h3>\n

(at least, not properly!)<\/em><\/span><\/h3>\n

I\u2019m a member of a few Facebook disability support groups. For people with spinal injuries generally and in particular, those caused by Cauda Equine Syndrome (CES), \u2018Piss<\/em>\u2018, \u2018Poo<\/em>\u2018 & \u2018Pain<\/em>\u2018 are regular subjects, especially with people who are new to their disability or simply, people who struggled alone for a long time before finding likeminded people. I\u2019ve written repeatedly about my experiences which could offer some guidance to other people, but these are \u2018private\u2019 groups, and the \u2018repeatedly<\/strong><\/em>\u2018 is a bit of a pain, so I decided to put it all here, then I can just link to these pages in future.<\/p>\n

If you are coming here from one of the Facebook pages, I hope this information is useful. If you have further questions, feel free to email me;\u00a0keith.fitton@outlook.com<\/a><\/p>\n

I will separate the three P\u2019s<\/em> out in to individual blogs. This is number one of three.<\/p>\n

[Edit August 2020: How was this not \u201cnumber two\u2019s<\/strong> of three\u201d??? I\u2019m losing my touch!<\/em>]<\/p>\n

Okay, I\u2019m literally writing this blog while sitting in bed with a suppository up my bum, waiting for a rush to the toilet, where I will sit & shit for half an hour or so.<\/p>\n

Yes, this is what you can expect from this blog\u2026 seriously, the kittens link earlier if offended, as it isn\u2019t going to get any better!<\/em><\/p>\n

But before we go any further:<\/strong><\/p>\n

\n

DISCLAMER!!!\u00a0<\/strong><\/span><\/h1>\n

Some people will know I\u2019m a Registered Nurse. THIS BLOG IS NOT MEDICAL ADVICE<\/strong>! I am intending to give some generalised advice regarding what has worked for me and how I have reached the \u2018balances\u2019 that I have. There may be things that you will try that work for yourself, in particular regarding neuropathic pain management. They may work, they may not, but they won\u2019t do any harm. However, bowel & urine continence in particular should be discussed with a doctor or continence advisor. In the UK & Isle of Man, you should have access to a specialist continence advisor, who is generally a Registered Nurse. You may need a referral to a Urologist. Speak to your GP about such referrals. People in the USA or elsewhere, your systems are totally different, but discussion with a doctor, especially before making any major changes to bowel &\/or bladder management is highly important. Simply making changes because \u2018some bloke on the internet said so<\/em>\u2018 is rarely a good way to manage health! But it may give you some ideas to discuss with the appropriate professionals, especially if your doctor isn\u2019t familiar with these regimes.<\/p>\n

\n

First \u2018P\u2019\u2026 POO!<\/span><\/strong><\/p>\n

Or: \u2018Constipation, What to do About It?<\/em>\u2018
\nOr: \u2018I Dare Not Go Out Because My Bowels Move at Random Times<\/em>\u2018
\nOr: \u2018Did you hear about the constipated\u00a0<\/em>mathematician? He worked it out using a pencil\u2019<\/i><\/p>\n

Almost everyone with a spinal injury experiences changes to the way their bowel works. Generally, people become constipated, sometimes impacted<\/em> which is severe constipation. It is possible that this becomes a medical emergency. Sometimes people can be very constipated\/impacted and experience very watery fluid being passed but no faeces. This is known as\u00a0\u2018overflow diarrhoea<\/em>\u2018 or \u2018faecal overflow<\/em>\u2018. The \u2018cure\u2019 is to remove the hard stool that is causing a blockage, so it is important to understand that this isn\u2019t regular diarrhoea. Also, for some people, they will finally clear a very large, often constipated stool, then get diarrhoea for a while afterwards.<\/p>\n

This can be really disabling, often, as much as the inability to walk properly, because people are uncomfortable or in pain, stop enjoying food and daren\u2019t go out or far from a toilet in case the bowel suddenly moves. They can\u2019t plan anything because they don\u2019t know what is happening. And they have the embarrassment of faecal incontinence. They can\u2019t get on with \u2018life<\/em>\u2018.<\/p>\n

Did I say \u201cthey<\/em>\u201c? I mean \u2018we<\/em>\u2018. I\u2019ve had all of those in the past, including once shitting myself in a car with two friends present.<\/p>\n

Oh the joy<\/em>.<\/p>\n

At least it was my car.<\/p>\n

A bowel management regime now gives me the knowledge of when I will be evacuating my bowel and how.<\/p>\n

I use \u00a0a pattern based around \u2018The Southport Regime<\/em>\u2018. This is a regime to manage \u2018neurogenic bowel dysfunction<\/em>\u2018 which is what we call it if your bowel stops functioning normally after a spinal injury, including CES. It was initially devised at the Southport Spinal Injury Unit, an NHS service based (surprisingly enough) in Southport, England. The goal of the Southport Regime is to produce regular, \u201cpredictable<\/strong><\/em>\u201d\u00a0bowel movements that \u201ctakes less than an hour<\/strong><\/em>\u201c, thus keeping the \u2018intrusion<\/em>\u2018 in to our lives, to a minimum.<\/p>\n

Basically, the \u2018Southport Regime<\/em>\u2018 involves:<\/p>\n

    \n
  1. Monday evening<\/strong>: Oral laxatives (senna tablets, lactulose etc)<\/li>\n
  2. Tuesday morning<\/em>: Suppositories<\/li>\n
  3. Wednesday evening<\/strong>: Oral laxatives<\/li>\n
  4. Thursday morning<\/em>: Suppositories<\/li>\n
  5. Friday evening<\/strong>: Oral laxatives<\/li>\n
  6. Saturday morning<\/em>: Suppositories<\/li>\n
  7. Sunday, a day off!<\/li>\n<\/ol>\n

    It took me a bit of \u2018playing around\u2019 with the regime to find what worked best for me. Bearing in mind, I was working full time from December 2013 (having acquired my disability in May 2013) until November 2018, I needed a regime that worked consistently & predictably. I found that taking even eight senna tablets made absolutely no difference to me whatsoever. 10 ml of Lactulose syrup worked best for my oral aperient\u00a0<\/em>(\u2018softner\u2019). Over time, I also settled on every other day, with no \u2018day off\u2019. I found that going three days (by skipping Sunday<\/em>) the Monday stool was always more difficult to pass. However, this also means that if I have a specific reason, for example, if I have to travel early in the morning, I can \u2018skip\u2019 a day occasionally.<\/p>\n

    By planning ahead, I can insert some flexibility in to my routine by choosing when to insert a suppository.<\/p>\n

    \n
    \"\"
    Phosphate enema: For a full on clear out (not needed!)
    \u2018Microlax enema: For very hard stools (very rarely needed now)
    Lactulose: Horrible, sticky, yucky. Softens the faeces.
    Suppositories: Every other day.
    Gloves: Obviously!
    Lubricating Jelly: Be gentle! Just because you can\u2019t feel anymore, doesn\u2019t mean you won\u2019t cause damage.<\/figcaption><\/figure>\n
    \n

    A bloke goes back to his doctor. He says \u201cdoctor, for all the good these suppositories have done me, I may as well have stuck them up my arse<\/strong>\u201c\u2026\u00a0<\/em><\/p>\n

    Yes, suppositories go up your bum. They then melt and cause the bowel to move. The two main types of suppositories for bowel management are bisacodyl or glycerine. They work in slightly different ways. A doctor or specialist may suggest one or the other or even a combination of the two. Personally, I only use bisacodyl suppositories.<\/p>\n

    Enemas are another way of moving the bowel and some people use irrigation systems such as Peristeen, but they are different to what I\u2019m talking about here. I would suggest discussing with your doctor or continence specialist, an approach such as Southport Regime first<\/em>, then move on to other, more invasive approaches if needed. Obviously, some people will have been in rehab services etcetera where specialists skipped a regime such as Southport, because they can directly assess the damage to your spine.<\/p>\n

    This blog is aimed at people who don\u2019t have a working system! <\/em><\/p>\n

    At the risk of labouring the point, this is guidance regarding what worked for me, speak to a professional who can assess you properly\u00a0<\/strong>but there will be an answer if you look for it<\/span><\/span>.<\/em><\/p>\n

    When I was working, I would wake up at 7am on \u201cpoo days\u201d<\/em>. Stick the suppository up while still in bed, then have a brew and surf Facebook or check email for about half an hour or so. I then would sit on the toilet and await an explosion.<\/p>\n

    Sometimes, I would have a massive torpedo fly out of my bum at warp speed! A foot long stool would be passed literally in a second! Due to a lack of sensation in that area, I wouldn\u2019t feel it being passed but the sudden ejection would leave me feeling a bit sick further up my bowel. This feeling would be weirdly satisfying! Not at all pleasant, but \u2018satisfying<\/em>\u2018. I would tend to sit for a while longer, but rarely pass anything else.<\/p>\n

    On other occasions, it would be difficult to get going. I may have to sit for a while before gravity helped. I would sometimes have to strain. THIS IS NOT RECOMMENDED!<\/strong> But, sometimes it is needed. Occasionally, I would have a push, then stand up and holding some tissue against my anus, \u2018palpate\u2019 up and down. I would then sit back down and push all in one go. Very rarely, I would need to \u2018manually evacuate<\/em>\u2018 by inserting a finger.<\/p>\n

    This needs to be done very, VERY<\/em>, VERY<\/strong> gently!<\/p>\n

    Due to a lack of sensation in the area, it is much easier for someone with a spinal injury to cause damage without realising it.<\/p>\n

    Again, discuss with a professional<\/span><\/strong>.<\/p>\n

    The point is, even with a well managed bowel routine, there may still be changes in consistency and response. Diet is a huge influence. A high fibre diet, with lots of fruit & vegetables will lead to a healthier bowel and easier movement as well as a healthier lifestyle generally. My wife & I are trying, generally unsuccessfully, to have at least two vegetarian days every week. When we achieve this goal, I notice a difference in bowel movements. Also, exercise can make a big difference. Depending upon the type of injury you have will impact upon how easy or difficult it is to take part in exercise, but anything that you can do will be useful. My main exercise is wheelchair basketball which I blogged about previously<\/a>. It is very easy to fall in to a cycle of unhealthy living after acquiring a disability\u2026 less exercise & more isolation leading to eating less healthy food, more junk food or ready meals because they are easier, leading to feeling depressed so eating more cake and crap etcetera, etcetera, etcetera. These all change the way an already dysfunctional bowel works\u2026 or doesn\u2019t<\/em>. Likewise, worrying that you may be incontinent while out and about leads to becoming more socially isolated, again leading to depression, further withdrawal and again, more unhealthy lifestyle. It is a vicious circle, where life is limited, not by the injury to the spine, but because life revolves around bowels.<\/p>\n

    Establishing a good bowel routine took me a little while with some trial and error. I\u2019d recommend making small changes to laxatives etc rather than changing everything all in one go. When I was in rehab, I was taking Laxido, which is a laxative that comes in powder form, which is added to water to make a disgusting tasting concoction. I found that this was too vicious.<\/p>\n

    \"Laxido
    Laxido<\/strong>: For me, dynamite would be more gentle! For you, it may be perfect (but still taste horrible!)<\/figcaption><\/figure>\n

    Likewise, senna tablets made no difference whatsoever. If I\u2019ve been good and eaten a lot of vegetables with little or no meat, I will skip the Lactulose for a night. Generally though 10ml Lactulose at night and a 10mg bisacodyl suppository the following morning does the job.<\/p>\n

    Get to know your own body<\/span><\/strong>.<\/p>\n

    Tweak the regime as needed. The point I\u2019m trying to make is, I have a well established bowel regime but I don\u2019t do exactly the same thing day after day. So if my regime still occasionally requires tweaking, then there isn\u2019t a \u2018one size fits all<\/em>\u2018 for everyone reading this. But there will be \u2018something<\/em>\u2018 that works and gives you hope. If you are reading this because you are having difficulties around constipation or faecal incontinence, then hopefully this will give you some pointers as to where to begin regaining control. Speaking to a professional<\/strong> is the starting point, but ask them questions. Be an \u2018informed patient<\/em>\u2018. It may be that you need more active intervention, such as enemas or irrigation systems. But the important thing to know it that there are answers and you can regain control.<\/p>\n

    If you\u2019ve any questions, feel free to email me: keith.fitton@outlook.com<\/a><\/p>\n

    And if you came from a Facebook group directly to this page, if this was useful (or even just made you smile) please leave a comment and visit the main \u2018landing page\u2019 www.rollingwith.me<\/a> so that you can subscribe for future updates. Perhaps you\u2019ll enjoy reading the previous entries too?<\/p>\n

    The next two blog entries will cover \u2018Pee\u2019 & \u2018Pain\u2019.<\/p>\n

    Fun Fact for American Readers:\u00a0<\/strong><\/p>\n

    Words like \u2018faeces<\/em>\u2018 & \u2018colour<\/em>\u2018 are spelt differently over there, in part because of cost! In the USA, type setters were paid by the letter, so newspaper owners dropped the \u2018superfluous letters<\/em>\u2018 to make it cheaper to print news.<\/p>\n

    Also, at the time, there were inconsistencies in English spelling, even in England. There still are. For example, most Brits will write \u2018realise<\/em>\u2018 not \u2018realize<\/em>\u2018, even though both are correct. Across the pond, in 1828 \u2018Webster\u2019 developed the first US dictionary, in an attempt to standardise (or \u2018standardize<\/em>\u2018 as Webster would prefer) spelling throughout The New World<\/em>.<\/p>\n

    While many of us bemoan those in the colonies \u2018dumbing down<\/em>\u2018 of our language, in fact, we\u2019ve adopted some of Webster back over this way. For example, prior to 1828, words like \u2018music\u2019 were generally spelt \u2018musick<\/em>\u2018. As well as the \u2018U\u2019 in colour, which we desperately cling to, Webster removed the \u2018K\u2019 from \u2018publick<\/em>\u2018 which we accepted. Funny old world.<\/p>\n

    So returning to the subject;<\/p>\n

    If you want to soften the faeces<\/em><\/strong>, you should get with the programme<\/em><\/strong> &\u00a0centre<\/em><\/strong> in on a high fibre<\/em><\/strong> diet!<\/p>\n

    \u00a0<\/p>\n

    \u00a0<\/p>\n

    \u00a0<\/p>\n

    \u00a0<\/p>\n

    \u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

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