What is Neurogenic Bowel Dysfunction?

Neurogenic bowel occurs with the loss or absence of normal bowel function due to spinal cord injury or illness. Common conditions at risk for neurogenic bowel include:

When the spinal cord experiences illness or injury it damages the nerves that control the part of the colon responsible for sending solid waste out of the body. With neurogenic bowel the body no longer stores and/or eliminates waste like it did pre-injury, leading to constipation, fecal incontinence, and bowel accidents.

It’s essential for people with neurogenic bowel dysfunction to have an effective bowel management program to allow for optimum health and quality of life.

What are the Symptoms of Neurogenic Bowel?

Symptoms of neurogenic bowel include:

  • Constipation
  • Diarrhea
  • Difficulty passing stool
  • The inability to feel when the bowel is full
  • Nausea
  • Belly pain
  • Bowel accidents
  • Stool leakage

How is Neurogenic Bowel Treated?

The best way to treat neurogenic bowel is to have an effective bowel management program that ‘trains’ your bowels to ‘go’ on a more predictable and manageable basis.

A bowel management program is a daily routine for passing stool that fits with a person’s lifestyle and routine.

To determine the best bowel management program for your particular situation, it’s important to understand the degree of existing bowel function. This varies depending upon the nature of the illness, damage to the spinal cord, and/or completeness of a spinal cord injury.

  • Reflexive or upper motor neuron (“UMN”) bowel results from damage to the nerves that control the bowel.
  • Areflexic or lower motor neuron (“LMN”) results from damage below T-12, thus inhibiting the defecation reflex and relaxing the anal sphincter muscle.

If damage to the spinal cord is above T-12, there is a loss of the ability to sense a full rectum and the anal sphincter remains tight, causing bowel movements to occur on a reflex basis. When the rectum is full, the defecation reflex will occur. Loss of sphincter control can result in an inability to have a bowel movement and can lead to impaction, which can be serious.

A bowel program can be performed on a commode, however people at risk for skin breakdown need to evaluate the value of bowel care in a seated position vs. a side-lying position in bed. People with a LMN or flaccid bowel can start their program with digital stimulation or manual removal.

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What are the Essential Components of a Bowel Care Program?

Timing: Bowel movements usually occur 1 to 3 times a day, typically after a meal. The urge to ‘go’ is generally strongest for about 15 minutes in the first hour after breakfast, so an established morning bowel protocol is recommended. Before bed and about 30-40 minutes after a meal are other good times to perform bowel care as well.

Quality of Life: The least invasive and disruptive approach to neurogenic bowel management reduces discomfort and improves quality of life.The most natural form of elimination is the best long-term approach.

Bowel Chart: A daily bowel care chart is helpful to track the effectiveness of any program for neurogenic bowel to make adjustments and changes as needed. Here is a sample of a daily bowel chart:

Example Chart
Date Time of Evacuation Total Time for Bowel Care Fluid in ml Fiber in Grams Stool Consistency Bristol Stool chart Type 1-7 # of Incontinence Time Spent on Digital Stimulation Bowel Medication(s) Used
                 
                 
                 

Is there a Neurogenic Bowel Diet Regimen I Should Follow?

Diet, hydration, and exercise are key elements to an effective bowel management program for neurogenic bowel.

Fiber-Rich Foods

Consuming fiber-rich foods is one of the most important things you can do to manage your bowel care. Foods that are high in fiber include chickpeas, legumes, raspberries, broccoli, kidney beans, split peas, pears, avocado, and even dark chocolate!

Note: not everyone will benefit from a high-fiber diet. You need to recall how much fiber you had in your diet before your injury or disease versus how much you eat now. Speak with your healthcare professional to determine what is best for you.

Foods to Avoid

Just as it’s important to consume a balanced, fiber-rich diet, there are also foods and beverages to avoid or moderate. Sugar, caffeine, unhealthy fats, and sodium take a toll on overall health and do not promote healthy bowel movements. Beverages like caffeine, sugary sodas, and alcohol can deplete the body’s hydration.

Proper hydration

Proper hydration is another essential element of an effective bowel management program. Ample 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.

Physical movement

Physical movement also helps stimulate the bowel. For people with limited mobility, stretching and range of motion exercises are helpful to keep stool moving through the gastrointestinal tract.

Enemeez® Can Help with Proper Bowel Care

The Enemeez® formulation is a hyperosmotic, stool-softening laxative that works 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. This not only softens and loosens the stool, but it also initiates a normal, replicated bowel movement typically within 2-15 minutes.

Enemeez® plus contains 20mg of benzocaine, assisting in the anesthetization of the rectum and lower bowel. This formulation was developed for people who experience autonomic dysreflexia, hemorrhoids, fissures, or painful bowel movements.

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. Namey MA. Management of elimination dysfunction. In: Halper J, Holland NJ, eds. Comprehensive Nursing Care in Multiple Sclerosis. 2nd ed. New York, NY: Demos Medical Publishing; 2002:53-76.
  2. https://enemeez.com/wp-content/uploads/2020/07/ENZ010-Quality-Care-Bowel-Protocol-11.25.19-1.pdf
  3. https://www.cedars-sinai.org/health-library/diseases-and-conditions/n/neurogenic-bowel.html