Spinal cord injury (SCI) affects most aspects of a person’s life, and that of their loved ones. It impacts their physical, social, mental and emotional health.

It’s common to have loss of control over gastrointestinal function, along with motor function, which has a significant impact on bowel function.

Maintaining healthy bowel function is essential following SCI, not only for a person’s comfort and quality of life, but also because bowel function is connected to other essential bodily functions including the immune system.

Spinal cord injury affects an individual’s ability to move stool through the bowel, control emptying the bowel, and the ability to sense when the bowel is full. Due to these changes, people with spinal cord injury are susceptible to constipation, bowel leaking and/or stool accidents (incontinence), and fecal impaction.

How the Bowel Changes after Spinal Cord Injury

There are two main types of changes to bowel function following a spinal cord injury:

Upper motor neuron (“UMN”) bowel function results from the paralysis that damages the nerves that control the bowel. This is known as neurogenic bowel, and occurs with injuries at T12 and above. UMN bowel produces intact bowel reflexes and tightened anal sphincters.

Lower motor neuron (“LMN”) bowel function results from a spinal cord injury below T-12, thus damaging the defecation reflex and relaxing the anal sphincter muscle. This is known as a ‘flaccid bowel’.

With a neurogenic bowel, stool is emptied by reflex when the rectum is full, making defecation occur on a reflex basis. Bowel care can be managed by causing the bowel movement to occur at socially appropriate times and places.

With a flaccid bowel, when the bowel is full it attempts to signal the brain through the sacral nerve, instructing it to empty stool. The signal to evacuate doesn’t reach the spinal cord because the nerves are disrupted due to the spinal cord injury. Because the signal remains undetected, when enough stool has collected in the bowel, it empties on its own.

Spinal Cord Injury and Bowel Care Management

It’s essential to have a regular bowel care management program following a spinal cord injury, and it should address the following, at a minimum:
1. Provide a regular, predictable time for bowel evacuation that fits in with a person’s life and routine
2. Minimize or eliminate accidental bowel movements
3. Reduce risk of gastrointestinal complications

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What to Avoid with a Bowel Management Program

While every individual’s bowel program should be customized to fit their particular needs, there are some common pitfalls to avoid.

Change in Routine

It’s important to maintain a regular schedule for bowel movements whenever possible. Skipping or changing the program can result in constipation or bowel accidents.

Overuse of Stimulant Laxatives

It’s important to avoid overuse of stimulant laxatives for several reasons. There are adverse physical side effects, such as gas, bloating, cramping, and skin irritation/breakdown that are uncomfortable and often painful. The bowel can also become dependent on stimulant laxatives and lose its ability to empty stool without it.

Rushing

Bowel care should be performed efficiently, but not quickly. It’s important not to rush the process, which can result in injury, incomplete evacuation, or additional health complications.

Frequently Asked Questions

Constipation, fecal impaction, leaking, and accidents are three of the most common bowel complications following SCI. Constipation produces dry, hard stools that are difficult to pass. Leaking and accidents (fecal incontinence) is the inability to control the timing of bowel movements, resulting in involuntary emptying of the bowel.
Fecal impaction is when a bulk of solid stool builds up within the bowel and gets stuck, making regular bowel emptying methods ineffective. This typically occurs when an individual has been constipated for a long period of time.

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Disclaimer: The material contained is for reference purposes only. Alliance Labs, LLC and Summit Pharmaceuticals do not assume responsibility for patient care. Consult a physician prior to use. Copyright 2020 Summit Pharmaceuticals and Alliance Labs, LLC.

 

Sources:

  1. https://scireproject.com/community/topic/bowel/#bottom-line
  2. https://www.sci-info-pages.com/bowel-management/#:~:text=If%20the%20spinal%20cord%20injury,will%20occur%2C%20emptying%20the%20bowel.
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174229/