Spinal cord injury (SCI) interferes with the signals sent between the brain and the bowel, making proper bowel care management essential to reduce the risk of injury, illness, or accidents.
Every injury is different, and every person will have different bowel care needs depending on their mobility and level of injury.
Quadriplegic Bowel Care
Injuries located at T12 and above (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 why it 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 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.
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 both reflex and flaccid bowel, a bowel management program is essential. This is a regular routine employed to empty the bowel, and can consist of a variety of methods, 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, 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.