Effective Bowel Program for Quadriplegic
Spinal cord injury (SCI) often causes a bowel problem by disrupting the way the brain and bowel communicate with each other about when the bowel needs to be emptied. When this system is disrupted the *bowel no longer works like it did pre-injury and causes complications that range from constipation to accidents.
The Relationship Between the Bowel and the Spinal CordThe appropriate bowel program for spinal cord injury depends upon the level of disorder, damage, and the completeness of the injury. Upper motor neuron (“UMN”) bowel results from the paralysis that damages the nerves that control the bowel. Lower motor neuron (“LMN”) results from a spinal cord injury below T-12, thus damaging the defecation reflex and relaxing the anal sphincter muscle. If the injury is located at T12 or higher the ability to feel when the rectum is full may be lost. The bowel empties by reflex and is called reflex bowel. With this type of injury, when the rectum is full, defecation will occur on a reflex basis. These cases can be managed by causing the bowel movement to occur at socially appropriate times and places. For L1 injuries or lower, or for high cervical cord injury, when the bowel fills with stool it sends a signal to the sacral nerves where it then tries to send this signal along the spinal cord. The signal to evacuate doesn't reach the spinal cord because the nerves are disrupted due to the injury. Because the signal to evacuate is not able to travel along the spinal cord, the reflex to evacuate doesn't happen, however, the sphincter muscle remains loose. If too much stool collects in the bowel, it will evacuate on its own. This is called a flaccid bowel and increases the risk of constipation and incontinence.
Effective Bowel Care ManagementEstablish a bowel program at a time of day that works with your lifestyle and daily habits. Ideally, a bowel program can be done on a commode, but people at risk for skin breakdown should evaluate the safety of bowel care in a seated position vs. a side-lying position in bed. Bowel training for spinal cord injury is typically needed to establish predictable bowel function. By sticking with an established bowel training program, it creates the optimum quality of life and independence for people with SCI. It’s important to establish the right bowel training program for you with the assistance of a qualified medical professional. Elements of a bowel training program typically include a review of the following:
- A review of medications
- Your overall health and medical history
- Frequency of bowel movements
- Nutrition, sleep, and exercise habits
- Whether the rectum is fully emptied at the time of a bowel movement
- Frequency of bowel movements
- Consistency and appearance of stool
HydrationFluid intake is essential to both a bowel and bladder management program. Adequate non-diuretic fluid intake helps keep stool moving through the gastrointestinal tract and reduces the risk of constipation. Drinking two or more quarts of water a day is ideal
Eat Fiber-Rich FoodsEating fiber-rich foods is one of the most important things you can do to manage your bowel health. There are nutritional bars that are high in fiber, and some give you as much as 20% of your daily fiber intake. Other foods that are high in fiber include chickpeas, raspberries, broccoli, kidney beans, split peas, pears, avocado, and even dark chocolate!
Follow a Regular Time ScheduleTo minimize bowel accidents, follow a regular schedule to “teach” the bowel when to have a movement. Find a time of day that fits with your lifestyle, and stick to it as much as possible. Bowel programs typically require 30-60 minutes to complete. It’s preferable to complete the bowel care program on the commode, however, those at risk for skin breakdown should evaluate whether a seated position versus a side-lying position in bed is best. Gravity can assist with bowel movements, so if a seated position on padded or inflatable seats) is possible, this can be helpful.
Evaluate MedicationsActive ingredient(s) in certain medications can affect the bowel, such as anticholinergic medications for bladder care which can cause bowel obstruction or constipation. Some antidepressant drugs, narcotic pain medications, and spasticity drugs like dantrolene sodium can also increase the risk of constipation.
Range of Motion ExercisesPhysical movement also helps stimulate the bowel. Stretching and range of motion exercises are helpful in keeping a regular bowel routine.
Enemeez® Can Help with Proper Bowel CareThe Enemeez® formulation functions as a stool-softening, hyperosmotic laxative by drawing water into the bowel from surrounding body tissues. The docusate sodium in this mini enema product acts as a softener by preparing the stool to readily mix with watery fluids. The increased mass of stool promotes bowel evacuation by stimulating nerve endings in the bowel lining and initiating peristalsis. Not only does it soften and loosen the stool, but it initiates a normal, replicated bowel movement within 2-15 minutes. Enemeez® Plus contains 20mg of benzocaine, assisting in the anesthetization of the rectum and lower bowel. This formulation was developed for patients who experience autonomic dysreflexia, hemorrhoids, fissures, or painful bowel movements. Visit our website to request free samples and learn more about how to use our products.
Sources: https://www.sci-info-pages.com/bowel-management/ https://www.christopherreeve.org/living-with-paralysis/health/secondary-conditions/bowel-management https://www.myshepherdconnection.org/sci/bowel-care/function-after-sci https://www.nursingtimes.net/clinical-archive/continence/effective-bowel-management-for-patients-after-spinal-cord-injury-18-05-2004/ https://www.spinalcord.com/blog/bowel-program-after-spinal-cord-injury