Bowel Movement after Spinal Cord Injury (SCI)

For people with a spinal cord injury (SCI) or paralysis, many aspects of life change. One area that people frequently wonder about is part of daily life: how do you have a bowel movement?

Post spinal cord injury or illness, the pathway between the bowel and the brain is often disrupted, affecting the signals sent by the bowel to the brain about when and how to pass stool.

The level of disruption depends on the level of disorder, damage, and completeness of the SCI.

Upper motor neuron bowel occurs with injuries at T-12 or higher, and results from paralysis that damages the nerves that control the bowel. When the rectum is full, defecation occurs reflexively and can lead to bowel accidents. This condition is also known as reflex bowel.

Lower motor neuron bowel results from injury below T-12 that damage the defecation reflex and relax the anal sphincter muscle. When the bowel fills with stool the sacral nerves try to send a signal to the spinal cord to defecate but the injury disrupts the signal. In this instance the reflex to evacuate doesn’t happen and the sphincter muscle remains loose, a condition also known as flaccid bowel. Flaccid bowel can cause incontinence and constipation.

Traditionally, How Have Paralyzed People Tended to Bowel Movements?

For people with SCI or limited mobility it’s vital to have a regular bowel management program. Every person’s program looks different depending on their unique situation, but there are common methods employed to assist with defecation.
Put simply, a bowel management program is a daily routine employed by individuals and/or caregivers to ensure defecation occurs on a routine basis and at socially appropriate times. A bowel management program trains the bowel to defecate at regular times and allows for optimum comfort, convenience, and independence.

Bowel management programs are structured around a person’s schedule, prior bowel habits, and current lifestyle.

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What Factors Affect a Bowel Management Program?

There are several factors to consider when structuring a bowel management program, including the following:

Previous Bowel History: Everyone’s version of what is a ‘normal’ pattern of bowel movements varies. It’s beneficial to mimic pre-injury bowel habits as much as possible. A daily bowel management program is common, but it’s advisable not to go more than 2-3 days without defection to reduce the risk of constipation and fecal impaction.

Timing: Routine is essential and bowel programs are typically performed at the same time each day. While everyone’s program is different, it is common for it to occur first thing in the morning, before bedtime, and/or approximately 30 minutes following a meal.

Stress: Bowel movements are impacted by stress, so when going through a particularly difficult time it’s important to ensure that a bowel management program reflects this. When experiencing side effects of stress like reduced or increased appetite and/or inability to relax, make modifications to the defecation schedule accordingly.

Privacy, Comfort, and Safety: People want to feel as comfortable as possible when moving their bowels. For example, if there is a shared bathroom, adjustments that allow for maximum privacy are key. The method of defecation should also allow for maximum comfort and safety. To let gravity help, it’s best to be upright on a toilet seat, raised toilet seat, or commode chair if mobility and safety allow for it.

Nutrition and Hydration: Everything a person eats and drinks impacts their bowel schedule. It’s essential to consume a balanced, nutritious diet that is high in fiber. Drinking plenty or water or other non-diuretic fluids also helps moisten stool and keep things moving. Avoiding foods high in fat, sodium, and sugar helps, as does avoiding or moderating caffeine and alcohol intake.

Fitness: Moving the body also helps move the bowels! A regular fitness routine helps keep things regular. For people with limited mobility, stretching and range of motion exercises are helpful.

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What are Some Online Tools that Can Be Used to Monitor Bowel Movements?

An ineffective bowel management program can lead to fecal impaction. This occurs when stool gets stuck in the bowel and it can cause dysreflexia and other serious health complications.

Signs of fecal impaction include:

  • No bowel movements for four days or longer, even with a bowel management program
  • Stool leakage
  • Nausea or vomiting
  • A tight or bloated abdomen
  • Back or stomach pain
  • Fever/sweating
  • Dizziness
  • Dehydration
  • Low blood pressure

It is important to contact a physician as soon as possible if you suspect you may have fecal impaction as this condition can worsen and even be fatal.

Gastrointestinal symptoms may or may not accompany fecal impaction. Heart, breathing, and circulation problems are a more common sign.

Overuse of laxatives is a common cause of fecal impaction. Dietary changes, little or no exercise, opioid pain medications, and untreated constipation are other common causes.

Removing a fecal impaction may involve manual removal of stool and/or use of a stool softener laxative. To help reduce risk of fecal impaction, it’s important to take a stool softener (as prescribed by a physician), maintain a regular fitness and/or range of motion routine, consume high-fiber foods, and stay hydrated.

What are Some Additional Ways for a Paralyzed Person to Control Bowel Movements?

There are several methods paralyzed people use to control bowel movements and which ones work best depends on an individual’s unique situation. Some of the more common methods include:

Digital Rectal Stimulation

Digital rectal stimulation involved inserting the index finger into the rectum and using a gentle circular motion to cause the anal sphicter to relax and pass stool.

Manual Removal

Manual removal is just what it sounds like and is the physical removal of stool from the rectum by inserting a finger into the rectum to remove stool.

Suppositories

The two main types of suppositories are both based on the active ingredient bisacodyl. One has a vegetable base and the other has a polyethylene glycol base. While bisacodyl, which is a stimulant laxative, can be effective it can also have some unpleasant side effects.

Mini-Enemas

Mini-enemas like Enemeez® are a popular option to assist with a bowel management program, as they work quickly and have minimal (or no) side effects.

Enemeez® Products Can Help with Proper Bowel Care

The Enemeez® formulation functions as a stool-softening laxative by drawing water into the bowel from surrounding body tissues. The docusate sodium in this mini enema product prepares the stool to readily mix with watery fluids. Not only does it soften and loosen the stool, but it initiates a normal, replicated bowel movement, typically within 2-15 minutes.

Join the Thrive Community!

We’ve gathered a number of inspiring individuals with disabilities in our very own Thrive Community! The Thrive Community Facebook Group is a private space for any person with a disability, as well as caregivers and healthcare providers that touch their lives.

Our purpose is to provide a safe, educational space for group members to ask every question, connect with their peers, and empower each other through communication and connection. Our conversations are led by incredible individuals who themselves are living and thriving.

For more enlightening resources, information, and discussion, join the Enemeez® Thrive Community today!

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 2021 Summit Pharmaceuticals and Alliance Labs, LLC.

 

Sources:
  1. https://www.sci-info-pages.com/bowel-management/#:~:text=If%20the%20spinal%20cord%20injury,will%20occur%2C%20emptying%20the%20bowel.
  2. https://www.christopherreeve.org/living-with-paralysis/health/secondary-conditions/bowel-management
  3. https://msktc.org/sci/factsheets/Bowel_Function