When a person has a spinal cord injury (SCI), they lose the capacity to sense when to defecate, along with many other complications.
Many people with paralysis also struggle with the seesaw impact of switching from constipation to diarrhea and spontaneous bowel movements, which may damage one’s quality of life.
Such bowel problems occur in paraplegics because spinal cord injuries can also affect the nerves that regulate bowel function.
Neurogenic bowel dysfunction is a painful, lifelong condition that impacts that affects around 80% of spinal cord injury patients, and it is of two types,
The degree of damage varies on the location of the spinal cord damage, like complete or incomplete spinal cord injuries.
- Reflexic bowel or upper motor neuron bowels. Also called a spastic bowel. Spinal cord damage above the T-12 level may lead to loss of rectal content feeling. The anal sphincter muscle, however, will remain contracted, resulting in only reflex bowel movements, and the defecation reflex will empty the bowel when the rectum is full. One solution is to regulate the conditions in which the defecation reflex occurs.
- Areflexic bowel or lower motor neuron bowels. The anal sphincter muscle can be weakened or damaged by a spinal cord lesion below the T-12 level, which can cause the defecation reflex to become ineffective, also naming it a flaccid bowel.
Areflexic bowel problem management may include more frequent efforts to empty the bowel, such as bearing down or manually evacuating stool.
Constipation, diarrhea, and impaction are all symptoms of neurogenic bowel, but they can be avoided with proper bowel management.
Expert opinion on how to manage bowel function
After a spinal cord injury, learning to control bowel movements can be a lengthy process of trial and error in a bowel program.
Amanda Quiniqe, an occupational therapist, explains spastic and flaccid bowels in the video concerning upper motor neuron and lower motor neuron.
Another occupational therapist, Patty Zuba, describes the best bowel program can be taking medications at night, having the best diet, having adequate fluid intake, use of suppositories or enemas. The best time to defecate via a bowel program can take 25 to 60 minutes; more than this can be re-evaluated with doctors and health care professionals.
Appropriate Bowel program for paraplegics
Regaining control of bowel function after spinal cord injury requires a comprehensive strategy, which is what a bowel program is all about.
The program aims to encourage frequent defecation, which consists of a daily routine designed to promote bowel movements at regular, hygienic intervals.
A bowel program takes around 60 minutes to complete and is adjusted based on a person’s schedule, prior bowel practices and digestive system, and present way of life.
Why is keeping healthy Bowels so essential?
Bowel dysfunction that worsens without treatment might cause further health issues.
- Worsening pain and spasticity
- Decreased quality of life.
- Abdominal pain or discomfort.
- Changes in weight.
- Rectal bleeding
- Colon cancer.
- Autonomic dysreflexia is a severe chronic condition that lowers heart rate and raises blood pressure in spinal cord injury patients above T6. Left untreated, it can induce stroke, ocular bleeding, heart or lung enlargement, and more.
Objectives of a Bowel Program for Spinal Cord Injury Patients
The purpose of a bowel program is to improve your quality of life by:
- Prevent unplanned bowel movements.
- Expel sufficient stools throughout each bowel treatment session at regular and predictable intervals.
Emptying bowel completely at the same time of the day.
- Facilitate bowel movements so you may do them in a fair amount of time.
- Minimize bowel-related health problems and other concerns.
Have a plan to get help with the bathroom routine if needed.
Components of Bowel Program
Each individual’s bowel program should be tailored to their specific needs. In addition to other criteria, the level of nerve injury (such as upper or lower motor neurons or complete or incomplete spinal cord injury) should be considered.
Some other well-researched components that are to be kept in mind include,
Bowel function might be affected by how active you are. Keeping active and moving around often throughout the day will boost your metabolism and blood flow, and your body’s digestive systems will be more effective quicker.
Exercise, changing how you carry your weight, and doing range-of-motion exercises are all examples of regular movement or activity that might aid bowel management,
Expect the bowel routine to alter if your level of exercise does, too, such as laziness or fever that may restrict your movement.
- Eating Habits
Your bowel routine is susceptible to what you consume, so it’s best to stick to whole foods whenever available.
Consistency in eating properly is the most critical factor for a successful bowel program. Avoiding processed and fatty meals and replacing them with raw produce, lean proteins, and fiber-rich whole grains is essential. Additionally, make an effort to eat well on a regular schedule.
- Add up Fiber to your Diet
For better bowel function, paraplegics have always been prescribed a high-fiber diet by doctors. Eating a wide range of foods is the easiest way to ensure you get enough fiber.
Aim for 15 grams of fiber daily to get things off on the right foot. Fiber-rich foods include raspberries, beans, peas, whole wheat pasta, barley, popcorn, lentils, chia seeds, and peas.
Many medicated options, such as fiber bars, psyllium husk, or gummies, are available in the market for ease.
Just ensure that you consume daily fiber to notice the effects.
Taking probiotics can help manage the bowels. They introduce beneficial bacteria into the digestive system. This beneficial bacterium can reduce diarrhea and promote regular bowel movements, but this can take up to 3 weeks to show results.
- Magnesium can help
You can regulate your bowel motions by taking the supplement magnesium available at any drugstore. Many individuals take magnesium at night to have regular bowel movements in the morning.
- Hydration for better bowel movements.
Keeping your stools soft and avoiding constipation requires a daily commitment to drinking enough water. A fair rule of thumb is 64 ounces daily (alcohol and caffeinated drinks are not included).
Drinking additional water if you’re exercising vigorously or if it’s warm outside is also recommended. Make sure you’re getting enough fluids by observing your pee’s color (pale yellow is ideal).
The bladder program may require some people to reduce their water intake. If that’s the case, discussing a healthy daily fluid goal that supports your bladder and bowel routines with a healthcare provider is essential.
Coffee’s caffeine stimulates bowel movements. While it’s not the most potent cure for constipation, it can benefit those with occasional issues. Remember that caffeine dehydrates the body, which can lead to constipation if used in excess.
Timing matters a lot in a bowel management program, so maintaining a daily routine for bowel movements is essential and recommended.
You can better anticipate when you need to empty your bowels and avoid accidents if you adhere to a timetable and carry out the same activities at around the same time every day.
Even though everyone’s bowel schedule is different, most people need to use the restroom first thing in the morning, then 30 minutes after eating, and one more before night.
Gravity may facilitate defecation when a person is seated upright on a commode chair or a cushioned toilet seat. Try bending forward if you’re having trouble passing the stool when seated, as it will form a steep angle to ease the bowel movement.
You may support your body weight while pushing the stool by placing your feet on footrests or footstool.
Recommendations for Safe Bowels
Use these guidelines to safely operate bowel care equipment to lessen the risk of falls and pressure ulcers. Ask your doctor or other medical professionals to demonstrate the proper use of aids or stimulant drugs.
- Careful seat use can prevent pressure sores and other skin issues. Talk to an OT about your needs before making any purchases.
- Don’t use a seat that has cracked or damaged vinyl, broken seams, or unpadded, as it can damage the skin.
- Stay balanced while on the seat and keep up a correct posture.
- Cleaning fingernails and handwashing after removing and replacing gloves are equally important.
- To avoid the discomfort caused by extended pressure on the same skin area, move from your seat and take on a new posture.
Depending on the circumstances, spinal cord injury patients may utilize a variety of medications and techniques to manage or address bowel movements.
The stool can be moved through the colon and into the rectum by rubbing or running a hand firmly over the abdomen in a circular direction, starting at the lower right and working up and along the left side. It has also been found that massaging the upper right and left sides of the pelvis is beneficial.
This method is most effective for those with areflexic bowel, which have control over their abdominal muscles and can assist in pushing stool out.
If you have a history of cardiac issues, talk to your doctor before attempting any Valsalva maneuvers, as it increases the risk of bladder spasms and autonomic dysreflexia.
Due to variations in needs and responses to the program parts, there is no one-size-fits-all solution. Your needs differ from those of others, and you may have to try out a few variations on your bowel program before you find the one that works best for you.
In some cases, your doctor may prescribe a combination of oral and rectally administered medications for different bowel programs, including but not limited to the following:
- A stool softener will make the stool pliable and less bothersome to move about, treating constipation and fecal impaction.
- Laxatives that promote bowel regularity by increasing stool bulk can be used to control diarrhea (watery stools). You can take a laxative if you have either a reflexive or an areflexic bowel.
- Rectal Laxatives inserted rectally promote bowel movement and encourage the bowels to empty.
- Suppositories. The body’s heat dissolves chemical stimulants (bisacodyl and glycerin) in suppositories administered into the rectum. Their action stimulates rectal nerves, allowing people to defecate at their own will. Suppositories should only be used by those who have reflexive bowels.
- Enemas are a type of rectal infusion therapy in which a liquid drug is injected into the rectum to loosen and soften the stool before discharge, aiding in bowel evacuation.This method is normal since adverse effects are negligible or practically nonexistent.
People with spinal cord injuries can now have regular bowel movements in a bowel program thanks to digital stimulation, which works by relaxing and expanding the anal muscles. Circular finger movements are used to open the anus manually.
A bowel reflex is triggered, and waste is expelled, relaxing a neurogenic bowel dysfunction. In contrast to other methods, digital stimulation is not commonly employed in bowel programs.
This video explains the procedure of digital stimulation for perfect bowels in spinal cord injury patients.
What if all the above methods fail?
A person’s bowel program should be examined at least once a year to treat neurogenic bowel effectively and rule out complications like autonomic dysreflexia, rectal bleeding, intestinal infection, and chronic constipation.
But if the above methods are no longer helpful, a surgical procedure is usually utilized.
A colostomy is a surgical operation that connects the colon to a hole in the abdominal wall to form an artificial anus. It reduces gastrointestinal hospitalizations and improves physical health, psychological adjustment, and self-efficacy. Only patients who have tried every therapeutic option for bowel management with no success undergo this procedure.
Antegrade Continence Enema. Surgeons cut the abdominal wall to access the ascending colon. Then, an enema is placed inside the opening, and wash the colon with 500–1000 mL L tap water daily. Regular colon cleansing lowers bowel motions and stool incontinence.
Real Life Experiences of people with spinal cord injury
In this short video, a C7 spinal cord injury patient displays how he regulates his bowel habits independently using modified equipment.
This video shows Andrew, another spinal cord injury sufferer, how he manages his bowels with the help of liquid enemas and how he positions himself for his bowel movement.
Karen, who has paraplegia, shares his journey of trial and error about his bowel movements after his spinal cord injury. He shares a few tips, such as not eating after 9 pm at night, having his bowels early in the morning, using stool softeners, and using wipes and gloves to avoid bowel accidents.
In another video, a spinal cord injury patient tells his experiences of bowel programs he has followed in his 5-year paraplegic life. He uses suppositories and a chair for proper positioning. He also explained the best hygiene and tips that can help.
Planning and scheduling are necessary for bowel management following spinal cord injury. A well-planned bowel program aims to keep the intestines empty on a regular schedule to prevent accidents. Maintaining a routine about your nutrition, fluid intake, physical exercise, medication, timing, positioning, and any necessary aids can help you get on the right track with your injury and bowel program.
Before You Go
Spinal cord injuries always come with additional problems, such as stress, low sex drive, and bladder and bowel complications. You can learn more about how paraplegics pee and poo in my article here. Also, check out my other article for recovering bladder control if you want to understand how to deal with bladder issues after a spinal cord injury.