H.21 Adaptive Equipment for Mini Enema Use for Individuals with Tetraplegia

When individuals sustain a spinal cord injury, the gastrointestinal system of the body is often adversely affected as much of the system is controlled by the nerves exiting the sacral segments of the spinal cord. This impairs individuals’ ability to have a bowel movement on command and this must be compensated for by one of three different neurogenic bowel management options: digital stimulation, chemical evacuation or manual evacuation. Each intervention has its own pros and cons in terms of effectiveness, time involved, cost and caregiver burden and the most appropriate intervention should be determined by reviewing them thoroughly in consideration of the individual’s specific needs. When neurogenic bowel status is well-managed, a person with spinal cord injury can return to daily activities, life roles and community engagement without significant fear of incontinence. 

Two different forms of chemical bowel management exist: suppository and mini enema (Enemeez mini enema is the most form on the market currently). Both require preservation of at least moderate proximal upper extremity function and significant fine motor dexterity to insert into the rectum and deploy. Adaptive equipment already exists for suppository insertion that compensates for fine motor deficits. It involves a long handled, spring-loaded suppository inserter that is stabilized to a patient’s hand. There are currently no compensatory methods for mini enema insertion designed for the individual with a spinal cord injury who is unable to squeeze the small tube sufficiently to empty the liquid into the rectum. Compact water enema devices do exist. However, they lack the structure to add the chemical agent to and require fine motor preservation to operate.

If adaptive equipment were to be developed, it would allow a person with limited hand function to deploy a liquid enema independently. This would allow for decreased caregiver burden, more efficient and more effective bowel movements for those who need this program. It would also allow for the mini enema, which has benefits over other methods in terms of efficiency and effectiveness, to be considered as a self-management option for individuals with tetraplegia.