Can Spinal Injuries Cause Bowel Problems?
Spinal cord injury or illness is life-changing in many ways and often impacts a person’s physical, social, mental and emotional health and wellbeing.
Post spinal cord injury (SCI) or illness, it is common to have loss of control over gastrointestinal function, along with motor function, which is known as Neurogenic Bowel Dysfunction1. Learning healthy and effective ways to manage bowel function is an important aspect to the overall well-being and independence of a person who is living with SCI or a spinal-related illness.
What is Neurogenic Bowel Dysfunction?
Neurogenic Bowel Dysfunction (NBD) can occur when spinal cord injury or illness disrupts the signal between the brain and the bowel that travels along the spinal column. This affects an individual’s ability to move stool through the bowel, control when and how to empty the bowel, and the ability to sense when the bowel is full 2.
Due to these changes, digestive disorders such as constipation, bowel leaking and/or stool accidents (fecal incontinence), and fecal impaction occur.
Maintaining healthy bowel function is essential following SCI or illness, not only for a person’s comfort, independence, and quality of life, but also because bowel function is connected to other essential bodily functions including the immune system.
In addition to spinal cord injury, neurological disease and genetic disorders can also affect bowel function, such as NBD, Multiple Sclerosis, Spina Bifida, amyotrophic lateral sclerosis (ALS), progressive bulbar palsy (PBP), primary lateral sclerosis (PLS), and spinal muscular atrophy (SMA)3.
NOTE: As each injury, illness, disease, and disorder is different, every person will have different bowel care needs depending on their mobility and level of current diagnosis.
What is Spinal Muscular Atrophy?
Spinal muscular atrophy (SMA) is a genetic motor neuron disorder that affects control over voluntary skeletal muscle activity, including the external anal sphincter. This disorder affects approximately 1 in every 6,000 babies4, is caused by a genetic mutation in the survival motor neuron (SMN) gene, and results in insufficient levels of the SMN protein that enables muscles and nerves to communicate with each other.
This disorder does not only affect newborn babies, but can occur in children and adolescents of any age4, so it is important to know the signs and symptoms of SMA disease.
Signs and Symptoms of SMA Disease
Symptoms of SMA disease range from mild to disabling based on how much functional SMN protein there is in nerve cells called motor neurons and vary in each individual5. Symptoms experienced depend on the age of disease onset. Newborn symptoms include facial paralysis, slow reaction to stimuli, lack of motor milestone achievement, and severe muscle weakness5.
As a child ages, SMA disease is most noticeable through weakness in the arms and legs, respiratory difficulties, curvature of the spine (scoliosis), and motor developmental delay5.
Quadriplegic Bowel Care
Spinal cord injuries located at T12 and above (known as upper motor neuron (UMN) injuries) can cause muscle spasms that tighten the colon.
With UMN injuries, the ability to feel when the rectum is full may be lost. The bowel empties by reflex, hence it is commonly referred to as ‘reflex bowel’6. With this type of injury, when the rectum is full, defecation will occur on a reflex basis.
These cases can be managed with a regular bowel program that allows stool to pass at socially appropriate times and places.
Paraplegic Bowel Care
For people with lower motor neuron (LMN) injuries located at T12 and below, the muscle tone of the colon is compromised, which can cause involuntary bowel movements. In this case, the spinal reflex may be reduced or lost.
This condition is known as flaccid bowel 6. In this case, It’s important to keep stool well-formed and keep the rectum clear of stool as much as possible to prevent or reduce accidents.
The Importance of a Bowel Management Program
With spinal cord injury and illness that affects gastrointestinal function, a bowel management program is essential. This is a regular routine employed to empty the bowel, and can consist of a variety of methods 7, depending on the nature and level of injury.
The most important aspect of any bowel program is that it prioritizes the health, safety, and comfort of the individual and allows for maximum quality of life and independence. Methods of stool removal vary, but may include:
Digital Stimulation: in some cases, digital stimulation of the rectum prompts a bowel movement, provided there aren’t any painful or uncomfortable sensations in the rectal area. This is accomplished with a circular motion of the index finger in the rectum, causing the anal sphincter to relax and evacuate the bowel.
Manual Removal: this involves the physical removal of stool from the rectum. The Valsalva maneuver can help; this involves a breathing technique that increases pressure in the chest (this should not be employed with people who have a heart condition).
Suppositories: the use of suppositories can help to produce a bowel movement after SCI. Ingredients in most suppositories include bisacodyl to stimulate and contract the rectum, or glycerine to pull water into the stool making it bulkier and easier to evacuate.
Mini-Enema: mini-enemas, like ENEMEEZ®, are a gentle, effective way to produce a fast bowel movement. They are most effective when used laying on the left side with bent knees, or sitting/kneeling on the toilet while leaning the head and chest forward. Mini-enemas lubricate and soften stool, as well as draw moisture from the surrounding tissues into the stool to stimulate evacuation.
Lifestyle and Wellness
Beyond methods of stool removal, there are several elements that influence an effective bowel care program 8, stool consistency, and comfort.
Hydration: it is essential to remain hydrated and drink plenty of non-diuretic fluids throughout the day. This helps keep stools moving, retains moisture in the stool, hydrates the gastrointestinal tract, and reduces the risk of constipation.
Regular Routine: Following a regular bowel routine helps “teach” the bowel when to have a movement. Pick times of the day that fit with your schedule and lifestyle and stick to it as much as possible. First thing in the morning, before bed, and 30-40 minutes after a meal are usually good times. It’s preferable to complete bowel care on the commode in a seated position or on an inflatable seat, if physically possible, to allow gravity to assist with the passing of stool.
Fitness: Moving the body helps keep stool moving! Stretching and range of motion exercises are helpful for people with limited mobility.
Medications: Certain medications affect the bowel, such as anticholinergic medications, antidepressants, spasticity drugs (like dantrolene sodium), and narcotic pain medications.
Consult with a physician for advice on whether medication changes could help with bowel movements.
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Disclaimer: The material contained is for reference purposes only. Quest Healthcare, A Division of Quest Products, LLC, does not assume responsibility for patient care. Consult a physician prior to use. Copyright 2023 Quest Healthcare, A Division of Quest Products, LLC.
- Neurogenic bowel dysfunction - PubMed (nih.gov)
- Neurogenic Bowel Dysfunction in Children and Adolescents - PMC (nih.gov)
- Spinal Muscular Atrophy (SMA) | Johns Hopkins Medicine
- Signs and Symptoms of Spinal Muscular Atrophy (SMA) - Diseases | Muscular Dystrophy Association (mda.org)
- Bowel Management In Spinal Cord Injuries | Reeve Foundation (christopherreeve.org)
- Quadriplegic Bowel Program - Craig Hospital