Guide to Setting Up a Bowel Regimen Protocol

All people with complete SCI have neurogenic bowel. Most people with incomplete SCI have some degree of bowel dysfunction.

The degree of bowel function post-injury depends upon the level of disorder, damage, and the completeness of the spinal cord injury.

Reflexive or upper motor neuron (“UMN”) bowel results from paralysis that damages the nerves that control the bowel.

Areflexic or 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 injury is above T-12, there is a loss of the ability to sense when the rectum is full, causing the anal sphincter to remain closed. In this instance, bowel movements occur on a reflex basis: when the rectum is full defecation reflex will occur. Loss of sphincter control may result in the inability to have a bowel movement and can lead to impaction, which can be serious.

A reflex bowel program typically involves digital stimulation, which is the manual removal of stool with a gloved finger or dil stick. Manual stool removal can be followed by the use of a laxative product, such as an ENEMEEZ® mini enema, along with circular movement of the finger inside the rectum once the laxative product begins to take effect.

A flaccid bowel program typically consists of manual-only/digital stimulation. After the removal of any reachable stool, it can also be effective to rotate a gloved finger around inside the rectum, massage the stomach, and physical movement to get stool moving.

A bowel management program takes into account the nature of SCI, availability of attendant care, personal goals, life schedules, employment, and quality of life.

Neurogenic bowel programs are typically initiated during acute care and continued throughout life unless full recovery of bowel function returns. Careful measures must be taken to avoid pressure ulcers and falls.

In addition to risk of physical complications, social and emotional support should be available to help manage the emotional and mental impact associated with SCI and bowel management.

All aspects of a bowel care should be designed to be easily replicated in the home and community environment. Constipation care to minimize risk of further health complications and bowel accidents is especially important.

Establish a bowel management routine at time(s) of day that fit with your lifestyle. Ideally, bowel care can be done on the commode, however people at risk for skin breakdown need to take into consideration the value of bowel care in a seated position vs. a side-lying position in bed. People with an LMN or flaccid bowel may start their program with digital stimulation or manual removal.

Elements of a Bowel Management Program

After consulting with a qualified medical professional, a bowel management regimen may include some, or all, or the following:

Timing: Bowel movements can occur 1 to 3 times a day, usually after a meal. The need to ‘go’ is typically greatest in the first hour after breakfast, so an established morning bowel care program is recommended. Depending on the nature of your injury, leaning forward while seated on the toilet when having a bowel movement may help focus your attention on your lower abdomen, instead of your rectum, when passing stool.

Approach: Finding the least invasive approach to bowel care reduces discomfort and improves quality of life. Bear in mind that the most natural form of elimination is the best long-term approach.

Keeping a Bowel Chart: A daily bowel care chart is helpful to track the effectiveness of any bowel management program. It’s important to have the ability to take note of what works well and what doesn’t and to make changes accordingly.

A review of medications. Certain medications can affect the bowel and cause obstruction or constipation. Anticholinergics, antidepressants, narcotic pain medications, and spasticity drugs are some examples.

Nutritional habits. Consuming fiber-rich foods is one of the most important things you can do to manage your bowel care.

Sugar, caffeine, unhealthy fats, and sodium take a toll on overall health and do not promote healthy bowel movements. Be mindful of your overall diet and keep unhealthy foods and beverages to a minimum, or even better eliminate them altogether!

Fitness: Don’t forget about exercise! Moving your body is one of the most effective ways to get your stools moving. Create a fitness routine that is sustainable and manageable with your schedule. Stretching, light yoga, and range of motion exercises are helpful in keeping a regular bowel routine.

Hydration: Proper fluid 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.