Neurogenic bowel dysfunction can significantly interfere with one’s everyday life, so setting up a bowel program for spinal cord injury patients is a must.
The goals for establishing a bowel program for spinal cord injury patients involve achieving regular bowel movements, preventing constipation, and avoiding waste-related accidents.
This article will explain how spinal cord injury can affect bowel functions and the most important factors to consider when developing a successful bowel program.
With that being said, you should be working closely with your physician, rehab nurses, and occupational therapist to initiate this bowel program.
How Level Of Injury Affects Your Bowel Functions
Neurogenic bowel dysfunction can generally be split into 2 categories: ‘T12 and above’ and ‘L1 and below.’
T12 and Above
Spinal cord injuries at the T12 level and above result in reflexive (aka upper motor neuron) bowels.
With reflexive bowel, the anal sphincter stays tight and patients experience difficulties relaxing it, which is necessary to remove bowel waste.
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 the L1 level and below result in flaccid (aka areflexive or lower motor neuron) bowels.
Individuals will experience loose bowel muscles due to the absence of their anal and bulbocavernosus reflexes.
Because the muscles are loose, individuals are more prone to accidents.
Those with flaccid bowels should perform their bowel programs more frequently than those with reflexive bowels (daily, compared to every other day for reflexive bowels)
Now that you understand how level of injury can affect control over your bowel movements, let’s discuss important factors to consider when developing a bowel program.
Key Factors of a Successful Bowel Program for Spinal Cord Injury
The ideal bowel program will vary for each individual depending on their particular injury, their lifestyle, and preferences.
Below, we’ll go over 7 key factors that should be considered when developing a bowel program for spinal cord injury patients.
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, including 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 bowel 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.
Additionally, if you have flaccid bowels (lower motor neuron, L1 and below), you actually want your stool to be a little drier to reduce accidents (but this does NOT mean you should avoid drinking water!)
2. Activity Levels
Did you know that how much and how often you move can affect your bowel movements?
Intense exercise is not necessary to promote bowel movements. Generally, the movements used to perform everyday activities is enough to stimulate bowel movements.
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.
While a spinal cord injury can limit mobility, 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, so you may want to weigh out the pros and cons before taking new medications.
While laxatives can help with bowel complications like constipation, individuals can build a tolerance to them and may experience unfavorable side effects. As a result, they may not be ideal for long-term use.
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 to deliver chemical stimulants that melt/dissolve with the body’s natural heat.
They work by stimulating the nerves of the rectum so that individuals can regulate when they empty their bowel. Only individuals with reflexive (upper motor neuron, T12 and above) bowels would want to use a suppository – they are not appropriate for flaccid/areflexive bowels (lower motor neuron, L1 and below).
5. Digital Stimulation
Digital stimulation relaxes and expands the anal muscles so spinal cord injury patients can have regular bowel movements.
Make sure to wear gloves and use a lubricant when performing digital stimulation. It involves manually opening the anus with circular motions of the finger. It stimulates a bowel reflex that allows your stool to exit the body.
If you’d rather not use your finger, consider purchasing a suppository inserter to substitute. One of your rehab providers will need to show you how to perform digital stimulation safely, as there are risks associated with it (tearing/bleeding and triggering autonomic dysreflexia, etc.)
Another significant factor to consider when implementing a bowel program for spinal cord injury patients is timing.
Ultimately, patients should aim to have 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, individuals are able to better predict when they should empty their bowels and prevent accidents.
Keep in mind that individuals often need to take medications much earlier than they plan to empty their bowels.
Transferring (i.e. moving from one surface to another) should definitely be considered when creating a bowel program for spinal cord injury patients.
Think about how the patient is going to get on the toilet and whether they will need adaptive tools like a commode chair or raised toilet seat for convenience and safety.
It’s best to be seated during bowel movements so that gravity can help move the stool down the colon. However, individuals who cannot sit should lay on their left side as it corresponds with the direction of the colon.
Setting Up a Bowel Program for Spinal Cord Injury Patients: Key Points
We highly suggest promoting bowel movements through changes in activity, diet, and fluid intake before trying medications, as they can come with undesirable side effects.
Bowel programs should be personalized for each spinal cord injury patient’s functional abilities, lifestyle, and preferences. It often takes several weeks and a whole team of rehab professionals working together along with the patient in order to determine the appropriate bowel program for each individual, so don’t try to do this alone!
Hopefully, this article provided some helpful insight on how to establish a bowel program for spinal cord injury patients.
If you’d like to find out how to manage bladder problems after SCI, check out our article on Neurogenic Bladder Dysfunction. Good luck!