Faecal Impaction in MS

MS didn’t only affect Pete’s legs; it started to have an impact on his bowels amongst other things. The demyelination or nerve damage started interfering with his “pushing action” and he found it more and more difficult having a bowel movement.

It got so bad, he sometimes sat on the toilet for up to three hours trying to go. Sometimes he would succeed but the majority of the time he didn’t. Because of this problem he became chronically constipated.

The trouble is, one of the signs of being chronically constipated is losing brown watery fluid so then you think you have diarrhoea! Not so. When you have a mass of faeces left in your bowel which cannot be evacuated, a build up of fluid surrounds the mass, and because this fluid cannot penetrate the mass, it eventually comes away through the anus.

Because Pete thought he had diarrhoea he started taking Imodium which would obviously make matters worse. But we weren’t told this at the time. So we both did what we thought was best. You need to have an understanding of what is going on in the bowel.

He was prescribed all types of medication to treat constipation. Movicol was a stool softener and he was also prescribed a stimulant. When he had taken these (the night before), the following morning the district nurse would come in to give him an enema and a suppository. Then she would go. The carers would then have to sort out the bowel movement which followed. Because gravity helped, Pete would be left dangling on the hoist in mid-air while the results of all this medication began to work. He had no dignity.

Manual Evacuation

This procedure continued for a couple of years before the next stage. Pete’s body got used to all the medication and enemas and they stopped having an effect, so the district nurse would come in once a week to give a manual evacuation.

This is a procedure where the insertion of a gloved finger coated in lubricant is pushed up into the patient’s rectum to manually evacuate the contents of the rectum. This was done after an enema was given although this wasn't always necessary. The finger is gently rotated around the faeces which stimulates the bowel reflex usually producing a good result. Incontinence pads were positioned beforehand to protect the bed.

We were told by the district nurse that this method is inflicting abuse on a patient so this procedure was carried out very reluctantly but was the only method that worked.

Pete was greatly relieved after the procedure but after a couple of days, the feeling of needing to go would start causing him severe distress again, and it didn’t matter how much I begged and pleaded, the district nurses refused point blank to come more than once a week to do this. So poor Pete had to go a whole week in complete discomfort before “evacuation day”. After another couple of years using this method, a colostomy was suggested.

A colostomy is a surgical procedure that involves connecting a part of the colon onto the front of the abdominal wall, leaving the patient with an opening on the abdomen called a stoma. In a colostomy, the stoma is formed from the end of the large intestine, which is drawn out through the incision and sutured to the skin. After a colostomy, faeces leave the patient's body through the stoma.

He really didn’t want to go through this operation as it is quite a major thing to have to go through, with a lot of after care. We spoke in depth about it and decided to go ahead with the operation because Pete’s life was now being controlled by his bowels.

After the operation it took a while for things to settle down and heal and I was taught how to change the stoma bag and base plate because Pete would never have been able to change it himself.

You can cut the correct size hole yourself in the base plate or this can be done for you.

Here is the base plate with the correct size hole cut out. This is placed around the stoma and the bag locks onto this. You have to shave the hairs off before you stick down the base plate, otherwise it won't stick properly. I also use Hypafix around the base plate as well for extra security.

This procedure changed both our lives.