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Bowel Management

A spinal cord injury can affect nearly every bodily function. Changes in bowel habits are also common as the injury blocks messages coming to and from your brain preventing your body from knowing when you need to empty your bowel. This video explores how the nature of the SCI contributes to changes in the bowel and how important it is to listen to your body to manage the condition with good bowel habits.

The Living With a Spinal Cord Injury series is made possible by a gift from David and Barbara Loeb.  

View other videos in this series


Narrator: A spinal cord injury can affect nearly every bodily function. Just as you may experience changes in movement, sensation, body temperature, and circulation, changes in your bowel habits are also common. Your injury can block the messages to and from your brain, preventing you from feeling and controlling when you need to empty your bowels. The level of your spinal injury will determine the type of neurogenic valve changes you may experience.

Based on the patient's level of injury will determine if they have an upper motor neuron or a lower motor neuron bowel. So that information is gained through the ASIA exam or also known as the ISNCSCI exam. So typically, T12 and above will lead us to go towards an upper motor neuron program, and T12 in below will lead us to go towards a flaccid bowel program.

An upper motor neuron bowel is spastic, or tight, and can have muscle spasms causing incomplete emptying.

The muscles are tensing out of the control of the patient with the tightness of the anal sphincter for a spastic bowel, we need to find a way to loosen that sphincter up and help the stool move out and evacuate. So, a lot of the times that is done through digital stimulation to try to loosen that muscle up and allow the stool to move through as part of the spastic bowel program. 

A lower motor neuron bowel is flaccid or asleep and does not get messages to empty. A flaccid bowel can become backed up, resulting in frequent bowel accidents.

Those muscles are loose. They're not really contracting in control of the person in any way. So that can be a problem with the stool also kind of leaking out if it's too soft. The person doesn't have necessarily the muscle control to tighten those muscles and keep the stool in there like we normally would as a healthy individual. So, with a flaccid bowel, constipation can occur because it has a slower time moving through the intestine and moving out. So, we need to bulk up the stool, so that it doesn't just make its way out on its own, so it's a predictable bowel movement. That way the person can have control, it goes with their lifestyle, and that they're not having accidents during the day. That's gonna allow them to be more active and do the things that they want to do during the day if they have control of their bowel.

Establishing a regular bowel routine will help to regulate this essential bodily function and help prevent the serious complications that can result from a flaccid or spastic bowel. Your bowel may not work the same way it used to before your injury. You may not be able to feel when you have to have a BM, or you may not be able to control the muscles leading to bowel accidents or constipation.

Ed S.:
The bowel program is put a suppository in. I usually sit for 45 minutes before I do anything, and after that, if I haven't gone, I start to digitally stimulate. And I haven't had any issues in quite some time now with the bowel program. 

Ed H.:
So, when it first happened, I was like, “You want me to do what? With what? Nah, that ain’t happening there.” But you end up doing it, and you know it's like anything you get used to it. 

I finger stimulate, then I wait a few minutes, and then I go. I guess I'm fortunate enough like I don't wear a diaper or anything. I try to pay as much attention to my body as possible. Because it's just be little things that you can know. But alright, I know when I get that feeling, I have like 10 minutes before I have to go.

A good bowel routine has to be first of all, done daily. And the reason why we want to do that daily is that you have a predictable bowel movement every day at the same time every day, to prevent accidents. So, you want to make sure that your bowel program, whether you're doing it in the evening or whether you're doing it in the morning depending on your lifestyle, you want to make sure that you're emptying so you don't have accidents throughout the day.

Some of the most common bowel medications used to assure you have a routine bowel movement are:
•    Colace - a stool softener to keep your stool formed, allowing it to move more easily through the colon without becoming constipated.
•    Seneca - a mild laxative, which assists with propulsion or movement of the stool throughout the intestines into the lower colon and rectum, and preparation for when you provide a distal medication. 
•    A suppository or medicated enema, which is absorbed through the bowel mucosa when inserted into your rectum to increase peristalsis or pushing out of the stool through the lower colon, to improve complete emptying.
•    Additional medications may be prescribed by your rehabilitation team based on your body's response to your individual program.
Always consult with your team to determine the best bowel program for you. Listening, learning, asking questions, and following up with your rehabilitation doctor and the rehab team will provide you with the best education and recommendations to assure you stay healthy and limit the potential bowel complications you might experience as someone living with an STI.

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