Rationale and procedure for performing digital removal of faeces

In a healthy person, normal stool output is estimated at approximately 150 g to 200 g per day (Royal College of Nursing (RCN), 2012). Bowel frequency ranges between three times a day and three times a week (RCN, 2012). Stool consistency can vary depending on gender, health and diet (for stool classification see the Bristol Stool Form Scale) (Norgine Pharmaceuticals, 2000; RCN, 2012). The process for rectal emptying is a voluntary action. Faeces move into the rectum, which causes rectal distension and evokes the desire to defecate—this term is known as the ‘call to stool’ (RCN, 2012).

Under normal circumstances, an individual adopts a sitting or squatting position allowing for straightening of the anorectal angle and the relaxation of the external anal sphincter and puborectalis muscle. There is a rise in abdominal pressure and the muscles of the anterior abdominal wall become tense to direct pressure down into the pelvis (RCN, 2012). Stool enters the lower rectum, which initiates a spontaneous recto-sigmoid contraction, and is pushed through the anal canal (RCN, 2012).