Neurogenic bowel dysfunction can greatly interfere with your everyday life, so setting up a bowel program for spinal cord injury is a must.
The goals for establishing a bowel program for spinal cord injury are to achieve regular bowel movements and prevent constipation so that you don’t have to worry about accidents.
With a spinal cord injury, you may not be able to control or feel when you need to empty your bowel because your brain cannot receive that message from your digestive system.
This article will teach you what the most important factors for developing a successful bowel program for spinal cord injury are.
How Level Of Injury Affects Your Bowel
Neurogenic bowel dysfunction can generally be split into 2 categories: ‘T12 and above’ and ‘L1 and below.’
T12 and Above
Spinal cord injuries at levels T12 and above result in reflex (aka upper motor neuron) bowels.
With reflex bowel, the anal sphincter stays tight and patients experience difficulties relaxing it.
However, the reflex that allows bowel movements to pass when the rectum is full still works, so unplanned bowel movements can occur.
L1 and Below
In contrast, spinal cord injuries at levels L1 and down result in flaccid (aka areflexic or lower motor neuron) bowels.
They result in loose muscles due to the absence of your anal and bulbocavernosus reflexes.
Because the muscles are loose, you’re more prone to accidents.
Those with flaccid bowels should perform their bowel programs more frequently than those with reflex bowels.
Key Factors of a Successful Bowel Program for Spinal Cord Injury
These 7 key factors play a huge role in regulating bowel movements after a spinal cord injury.
You may not need to utilize all of them. After some trial and error, you’ll see what combination of methods works best for you.
1. Diet and Water Intake
What you eat and drink plays a huge factor in bowel management.
Fiber will add bulk to your stool and promote movement throughout your digestive system.
Water will help soften the stool, which makes it easier to pass and prevents constipation.
Luckily, some foods are great sources of both fiber and water so you can knock 2 birds out with 1 stone!
These include most fruits and vegetables. For example, an apple is composed of 84% water and (with its skin) has 4.4 grams of fiber!
Other foods high in fiber include wholegrain bread, brown rice, nuts, beans, and seeds.
SCI patients with neurogenic bladder should aim to eat about 15-20 grams of fiber and drink at least 1.5 liters of water a day.
But don’t overdo it. Consuming too much fiber can cause bloating, gas, and constipation.
2. Activity Levels
Did you know that how much and how often you move can affect your bowel function?
You don’t need to do anything intense either. Even movements of daily living can help stimulate bowel movement.
How? It’s all about metabolism.
When you move a lot, your metabolism increases and when you don’t move, your body functions start to slow down.
Spinal cord injury will affect your mobility, but it’s also a great opportunity to get creative and find new ways to be active.
3. Oral Medications
Constipation and diarrhea are both common side effects of oral medications and you may want to weigh out the pros and cons before taking new medications.
While oral medications for constipation (like laxatives) exist, you can build a tolerance to them and may experience unfavorable side effects.
Other oral medications for bowel management after spinal cord injury include bulking agents and stool softeners.
4. Rectal Medications
Suppositories are inserted into the rectum and melt with your body’s natural heat.
They work by stimulating the nerves of your rectum so that you can regulate when you empty your bowel.
5. Digital Stimulation
Digital stimulation relaxes and expands the anal muscles so that you can have a regular bowel movement.
Make sure to wear gloves and use a lubricant when performing digital stimulation.
Essentially, you’re manually opening the anus with circular motions of your finger.
It stimulates a bowel reflex that allows your stool to exit the body.
If you rather not use your finger, consider purchasing a suppository inserter to substitute.
Another huge factor of a bowel program for spinal cord injury is timing.
Ultimately, you want a regular bowel movement around the same time every day or every other day.
By sticking to a schedule and performing the same tasks at around the same time every day, you’re able to better predict when you should empty your bowel and prevent accidents.
Keep in mind that you may need to take some medications much earlier than you plan to empty your bowel.
Positioning is something you definitely want to think about when creating a bowel program for spinal cord injury.
Think about how you’re going to get on the toilet and if you need a commode chair or raised toilet seat for convenience.
It’s best to stay seated so that gravity can help move the stool down your colon. However, if you can’t sit, lay on your left side.
A Specialized Bowel Program for Spinal Cord Injury
We highly suggest that you attempt to manage your bowel through changes in activity, diet, and fluid intake before trying medications, as they can come with undesirable side effects.
Be patient and don’t feel embarrassed if accidents happen along the way.
Your bowel program should be individualized for you and your specific spinal cord injury so take the time to see what works and what doesn’t work for you.
Pick a time that works best for your lifestyle.
Eventually, you’ll be able to manage your bowel and be able to carry on with your life without worrying about bowel-related accidents.
Hopefully, this article helped give provide some insight on how to establish a bowel program for spinal cord injury.
If you’d like to find out how to manage bladder problems after SCI, check out our article on Neurogenic Bladder Dysfunction. Good luck!