Spinal cord injury (SCI) or illness often causes bowel dysfunction by disrupting the communication pathways between the brain and the bowel. The spinal cord carries the message from the bowel to the brain that produces a voluntary relaxation of the anal sphincter muscles and the pelvic floor, allowing a bowel movement to occur.

When there is damage to the spinal cord, the bowel cannot effectively signal the brain that it needs emptying. This is known as neurogenic bowel dysfunction.

Multiple sclerosis, spina bifida, traumatic brain injury, Parkinson’s disease, diabetes, spinal cord injuries and other disorders can cause a disruption of the spinal pathway and can cause neurogenic bowel.

Bowel Function After Spinal Cord Injury or Illness

Bowel function after spinal cord injury or illness depends on the level of disorder and the completeness of the damage to the spinal cord.

Typically, upper motor neuron (“UMN”) damage affects the nerves that control the bowel, and lower motor neuron (“LMN”) damage inhibits the defecation reflex and the ability to relax the anal sphincter muscle.

If the damage to the spinal cord is located at T12 or higher, the ability to sense when the rectum is full may be partially or completely lost. In this instance, the bowel empties by reflex and as such is called ‘reflexic bowel’.

If the damage to the spinal cord is at L1 or lower (high cervical cord injury) the signal to evacuate the bowel cannot travel to the brain. The reflex to evacuate the bowel doesn’t happen but the anal sphincter muscle remains loose. This causes stool accumulating in the bowel to evacuate on its own, also known as ‘flaccid bowel’.

With both UMN and LMN injury or illness, it is essential to have an effective bowel management program to minimize bowel complications and maintain an optimum level of comfort, safety, and quality of life.

Risks of an Ineffective Bowel Management Program

An ineffective (or absent) bowel program can cause a myriad of health complications. Three of the most serious risks are:

  • constipation
  • fecal impaction
  • bowel obstruction

Other risks include:

  • Worsening pain and/or spasticity
  • Abdominal discomfort, pain, or distension
  • Nausea
  • Change in weight (related to a poor diet or a decrease in appetite)
  • Chronic heartburn
  • Hemorrhoids
  • Gas pain
  • Stomach or intestinal ulcers
  • Bloating or fullness
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Conditions, Diseases & Medications that Increase Constipation Risk

Constipation is the most common side effect of an ineffective bowel management program. It occurs when stool moves too slowly through the bowel, causing the body to absorb moisture from the stool and making it hard, dry, and difficult to pass.

While every person’s definition of a ‘normal’ bowel movement pattern is different, generally constipation means having fewer than three bowel movements per week. Risk of constipation increases with imposed immobility, a change in toileting habits, dietary changes, medications and stress.

Along with spinal cord injury or illness, there are other factors that can contribute to the risk of becoming constipated. These risk factors underscore the need to have an effective bowel management program.

Medications

Certain medications are more likely to have constipation as a potential side effect, including:

  • Pain medications (opioid medications in particular)
  • Medicines for anxiety and depression
  • Antacids
  • Diuretics
  • Supplements (examples include iron and calcium)

Intestinal Disorders

People with irritable bowel syndrome (IBS), diverticulitis (inflammation of the small pouches in the colon), Crohn’s disease, and colon cancer are more likely to develop constipation.

Muscle and Nerve Disorders

Stroke or any other disorder that causes paralysis in part of the body can cause nerve damage that may inhibit the ability to have a bowel movement without the assistance of a bowel management program.

The weakness of the abdominal muscles and/or diaphragm can make it difficult to push to pass stool.

Multiple sclerosis, muscular dystrophy, and Parkinson’s disease also put people at risk for constipation.

Lifestyle

Healthy habits play an important role in the reduction and prevention of constipation. It’s important to maintain a balanced diet that includes plenty of fiber. Adequate hydration is also vital for overall wellness and keeping stools moist and moving through the colon.

Changes in routine are another common cause of constipation. An effective bowel program helps ‘train’ the bowel to pass stool on a predictable schedule. Typically, first thing in the morning, before bed, and 30-40 minutes after a meal are recommended.

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Fecal Impaction

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.

Bowel Obstruction

A bowel obstruction occurs when a blockage prevents stool from moving through the intestines. Obstructions can be caused by a blockage either inside or outside the intestine.

Inside the intestine, swelling or a tumor can block the intestinal passageway. If a bowel obstruction is caused from outside the intestine, typically it is caused by an adjacent organ compressing or twisting a segment of the intestine.

Blockages of the large or small intestine can be partial or complete.

Common causes of blockages in the small intestine include:

  • Adhesions (typically from scarring)
  • Hernia
  • Tumors
  • Colorectal cancer
  • Volvulus (when a segment of the small intestine twists around itself)
  • Diverticular disease

It’s important to know the signs and symptoms of bowel obstruction and contact a physician immediately.

Symptoms of a small intestine obstruction include:

  • The inability to pass gas
  • Nausea and/or vomiting
  • Rapid pulse
  • Rapid breathing accompanied by cramping
  • Abdominal pain that comes in waves

Symptoms of a large intestine obstruction include:

  • Stool leakage
  • Intermittent episodes of constipation
  • Abdominal bloating

Typically, small intestine and large intestine blockage symptoms worsen over a period of hours, but a large intestine blockage caused by colorectal cancer or diverticular disease may produce symptoms over a longer period of time.

Treatment of a small intestine bowel obstruction typically involves the use of a nasogastric tube (NG tube) inserted into the stomach through the nose to remove excess gas. Intravenous fluids are given as it is not possible to eat or drink during treatment.

A complete bowel obstruction often requires surgery to remove or fix the cause of the blockage. This may or may not include removal of the damaged section of intestine.

An effective bowel management program, a balanced diet that includes plenty of fiber, hydration, and a regular fitness routine are important to help prevent risk of developing an intestinal blockage.

Frequently Asked Questions

A colostomy procedure is a surgery that creates an opening into the colon through the abdomen. Colostomies are often needed after bowel surgery. Temporary colostomies adhere the side of the colon to the abdominal opening, while “end colostomies” are permanent and involve bringing the end of the colon through the abdominal wall.