TBI Traumatic Brain Injury written in notebook

Though traumatic brain injury (TBI) can cause varying symptoms, one symptom that people typically speak about less openly is loss of bowel control. Before we discuss effective bowel management programs for people with TBI, however, it is important to focus on why a loss of bowel control occurs in the first place.

How does the bowel process typically function? When no injuries or illnesses are present, stool builds up in the rectum until the bowel signals the brain that it is time for a release. After a TBI, however, the bowel’s signal to the brain may be compromised, and this can cause ‘reflex bowel’, which occurs when the body doesn’t release stool at controlled times but unexpectedly and usually all at once. TBI can also cause ‘flaccid bowel’ which is when the rectum does not properly close and as a result stool consistently leaks through.

The Importance of Bowel Management for People with TBI

Post-TBI, it is important to implement effective bowel management regardless of whether you experience reflex or flaccid bowel. A regular bowel routine can help you retrain your body and regain control over when you release stool. Effective bowel management can also help avoid additional health problems, and provide an optimum quality of life and independence.

What is an Effective Bowel Management Program?

Depending on your situation, an effective bowel management program may consist of manual and/or laxative stool removal for a reflex bowel, or manual-only stool removal for flaccid bowels. Either option should be paired with ongoing lifestyle and stool management techniques to continue retraining the body.

Reflex Bowel Program

A reflex bowel program typically involves digital stimulation, which is the manual removal of stool with a gloved finger or dil stick. Manual stool removal can be followed by the use of a laxative product, such as an Enemeez® mini enema, along with circular movement of the finger inside the rectum once the laxative product begins to take effect.

Flaccid Bowel Program

A flaccid bowel program typically consists of manual-only stimulation, as laxative products are typically less effective for a flaccid bowel. After the removal of any reachable stool, it can also be effective to rotate a gloved finger around inside the rectum, massage the stomach, and get up and move around to keep the stool moving along.

Ongoing Bowel Management

Whether your TBI calls for a reflex bowel management program or a flaccid bowel management program, it is important to pair these programs with ongoing management techniques that retrain the body.

Establishing a routine is key. Programs should take place at the same time(s) each day to encourage the body to regulate and should be structured around lifestyle and medication schedules as well.

Bowel programs are most effective when supported by a healthy, balanced diet that includes your daily recommended fiber allowance. For example, eating a fiber-rich meal or drinking warm tea before beginning your bowel program each day can help get stool moving. It’s also important to remain hydrated with non-diuretic fluids throughout the day to soften stool. Proper sleep hygiene and a regular program of exercise also effectively support your bowel management program.

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.


  1. http://www.braininjurysupport.org/living-with-a-spinal-cord-injury/bowel-management/
  2. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Traumatic-Brain-Injury