Spinal Cord Injury Bowel Care

Spinal cord injury (SCI) causes complications in the functioning of the gastrointestinal system and makes proper bowel care management essential to minimize risk of injury or illness. It’s important to understand how SCI affects the digestive tract and how to properly manage bowel care for maximum health benefits and quality of life.

 

SCI disrupts the way the bowel system sends signals between the brain and bowel about when the bowel needs to be emptied. When this system is disrupted the bowel no longer works like it did pre-SCI, and can cause complications that range from constipation to accidents.

 

Paraplegics and quadriplegics have different needs when it comes to bowel care, so it’s also important to understand your unique bowel care needs based on your mobility and injury.

The Relationship Between the Bowel and the Spinal Cord

(Spinal Cord Diagram - click to enlarge)

If the injury is located at T12 or higher the ability to feel when the rectum is full may be lost. The bowel empties by reflex and is called “reflex bowel”. With this type of injury, when the rectum is full defecation will occur on a reflex basis. This can be managed by causing a bowel movement to occur at predictable times and places.

 

For L1 injuries or lower, or for high cervical cord injury, when the bowel fills with stool it sends a signal to the sacral nerves where it then tries to send this signal along the spinal cord. The signal to evacuate doesn’t reach the spinal cord because the nerves are disrupted due to the injury.

 

Because the signal to evacuate is not able to travel along the spinal cord, the reflex to evacuate doesn’t happen, however, the sphincter muscle remains loose. If too much stool collects in the bowel, it will evacuate on its own. This is called a “flaccid bowel” and increases the risk of constipation and incontinence.

What is Bowel Management After Spinal Cord Injury?

Quadriplegic Bowel Care

Upper motor neuron (UMN) injuries are typically located at T12 and above, and cause muscle spasms that tightens the colon. This is a “reflex bowel”.

For quadriplegic bowel care it’s important to have soft, formed stool to facilitate emptying of the bowel.

Every person will have different needs when it comes to their bowel management program, and it’s important to have a regular program in place that predictably evacuates the bowel to avoid health risk and provide the highest quality of life possible.

Paraplegic Bowel Care

For lower motor neuron (LMN) injuries located at T12 and below, the colon’s muscle tone is lost and involuntary bowel movements are more common.

Bowel intervention protocols like suppositories or digital stimulation may not be effective in this instance, due to absent or reduced spinal reflex.

Bowel care for paraplegics focuses on creating well formed stool and keeping the rectum clear of stool as much as possible to reduce or prevent accidents. Bowel management programs for people with LMN injuries vary, depending on the nature of the injury, however performing a bowel care program up to twice daily is recommended to keep the colon clear.

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Effective Bowel Care Management

It can take patience to figure out which bowel care management program works best for you. Don’t lose hope, however, because there are many options and steps you can take to improve your standard of living.

 

Effective bowel care management is a program that works with your lifestyle and your medical needs. Spinal cord injury doesn’t look the same for everyone, nor does the proper bowel program look the same for everyone. There are several elements that influence bowel care, stool consistency, and comfort, and several steps you can take to ensure your bowels are as healthy as possible.

woman in wheelchair drinking water for bowel care for paraplegics

Hydration and Bowel Care

Drinking water is essential to your bowel management program, as it helps keep stools moving, retains water in the stool, hydrates the gastrointestinal tract, and reduces the risk of constipation making it easier to empty your bowel and bladder. Drinking two or more quarts of water a day is ideal.

fiber rich foods to ensure bowel health

Eat Fiber-Rich Foods

Eating fiber-rich foods is one of the most important things you can do to manage your bowel care. There are nutritional bars that are high in fiber, and some give you as much as 20% of your daily fiber intake. Other foods that are high in fiber include chickpeas, raspberries, broccoli, kidney beans, split peas, pears, avocado, and even dark chocolate!

handicap bathroom for people with spinal injuries

Follow a Regular Bowel Routine

To minimize bowel accidents, follow a regular routine to “teach” the bowel when to have a movement. Find a time of day that fits with your lifestyle, and stick to it as much as possible. Bowel programs typically require 30-60 minutes to complete. It’s preferable to complete the bowel care program on the commode, however, those at risk for skin breakdown should evaluate whether a seated position versus a side-lying position in bed is best. Gravity can assist with bowel movements, so if a seated position on padded or inflatable seats is possible, this can be helpful.

medications

Evaluate Medications to Improve Bowel Movements

Certain medications can affect the bowel, such as anticholinergic medications for bladder care which can cause bowel obstruction or constipation. Some antidepressant drugs, narcotic pain medications, and spasticity drugs like dantrolene sodium can also increase the risk of constipation.

If you think your medications may be causing problems with your bowel care, it is important to consult a physician for advice and any needed medication changes.

young adult in wheelchair playing basketball

Range of Motion Exercises

Physical movement also helps stimulate the bowel. Stretching and range of motion exercises are helpful in keeping a regular bowel routine.

Methods for Emptying the Bowel and SCI

Constipation and fecal incontinence are common with neuromuscular-related paralysis, but there are proven methods that provide predictable results.

Depending on the nature of your injury and your needs, there are several ways you can complete or improve your regular bowel program. Bowel programs are most effective when completed on a regular schedule that fits with your lifestyle and your schedule.

Once you determine a bowel program that works best for you, it’s important to stick to the same program each day for maximum results. Bowel programs can take between 30-60 minutes to complete, and should be designed for maximum comfort and results that create more autonomy, health and wellbeing. Here are some methods commonly employed to evacuate the bowel:

Manual Removal

Manual removal is just how it sounds: the physical removal of stool from the rectum. The Valsalva maneuver can be helpful, and involves a breathing technique that increases pressure in the chest (but should not be used if you have a heart condition).

Digital Stimulation

Digital Stimulation of the rectum is a way to stimulate the bowel reflex after a spinal cord injury. It is best employed when there aren’t painful or uncomfortable sensations in the rectal area (pressure may be felt, but not pain). Digital stimulation is accomplished with a circular motion of the index finger in the rectum, causing the anal sphicter to relax and evacuate the bowel. It’s best to use digital stimulation as part of a regular bowel program, done at the same time/schedule each day to help prevent bowel accidents.

Suppositories

Suppositories are another way to produce a bowel movement after SCI. The ingredients in suppositories include bisacodyl to stimulate and contract the rectum, or glycerine to pull water into the stool which makes it bulkier and produces a bowel evacuation.

Mini-Enema

Mini-enemas are a gentle, effective way to produce a quick bowel movement. Enemeez mini-enemas typically produce results in 2-15 minutes. Mini-enemas are most effective when employed laying on the left side with bent knees, or sitting/kneeling on a toilet while bowing the head and chest forward.  Mini-enemas soften and lubricate stool, and also draw moisture into the stool to stimulate an evacuation.

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FAQs about Starting a Bowel Program

Every spinal cord injury is different, so the amount of control someone has over their bowels post-SCI varies. Most people do have some form of compromised bowel function, but again it varies depending on the location and nature of the injury.

man in wheelchair with daughter as an example of paraplegic bowel care

Enemeez® Can Help with Proper Bowel Care

The Enemeez® formulation functions as a stool-softening, hyperosmotic laxative by drawing water into the bowel from surrounding body tissues. The docusate sodium in this mini enema product acts as a softener by preparing the stool to readily mix with watery fluids. The increased mass of stool promotes bowel evacuation by stimulating nerve endings in the bowel lining and initiating peristalsis. Not only does it soften and loosen the stool, but it 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 patients who experience autonomic dysreflexia, hemorrhoids, fissures, or painful bowel movements.

Visit our website to request free samples, learn more about how to use our products, and access frequently asked questions.

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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://www.christopherreeve.org/living-with-paralysis/health/secondary-conditions/bowel-management
  2. https://craighospital.org/resources/bowel-program-getting-the-right-consistency
  3. https://www.sci-info-pages.com/bowel-management/
  4. https://www.myshepherdconnection.org/sci/bowel-care/function-after-sci