Bowel management

After a spinal cord injury (SCI), the way your bowel works can change significantly due to the disruption of communication between the brain and the nerves that control bowel function. Here's an overview of how bowel function is typically affected after SCI:

1. Loss of Sensation: Depending on the level and severity of the injury, individuals may experience a loss of sensation in the rectal area. This means you may not feel the urge to have a bowel movement or may have reduced sensation, making it difficult to determine when your bowel is full.

2. Loss of Muscle Control: SCI can affect the muscles in the rectum and anus that are responsible for controlling bowel movements. This loss of muscle control can lead to difficulties with sphincter control, resulting in incontinence or constipation.

3. Altered Reflexes: SCI can disrupt the reflexes that regulate bowel movements, leading to problems such as neurogenic bowel dysfunction. This condition can cause irregular bowel movements, constipation, or diarrhea.

4. Slowed Transit Time: SCI can slow down the transit time of stool through the colon, leading to constipation. This is due to reduced muscle activity in the intestines and a lack of coordination between the muscles involved in bowel movements.

5. Increased Risk of Complications: Individuals with SCI are at increased risk of bowel-related complications such as constipation, impaction, bowel obstruction, and autonomic dysreflexia. These complications can be serious and require prompt medical attention.

Managing bowel function after SCI often involves a combination of strategies, including dietary modifications, bowel training programs, medications, and the use of adaptive equipment. Developing a personalized bowel management plan with the help of healthcare professionals is essential to maintain bowel health and prevent complications. It's important to monitor bowel function closely and seek medical advice if you experience any changes or difficulties.

Two words you may hear to describe bowel type following SCI are reflex and flaccid.

Reflex bowel

Injuries above T12 level usually mean the bowel will continue to empty when stimulated. However, the sensation that indicates that the bowel is full is lost, and those messages carrying this information do not reach the brain.

The reflexes that partly control bowel movement are still present, meaning the muscles in your lower bowel, rectum and anal sphincter are still active, but you may have lost control of when they contract to empty the rectum. You or a carer may be able to trigger these contractions to empty your bowel at a convenient time. Ensuring the rectum is entirely empty is vital to avoid a bowel accident later in the day.

Flaccid bowel

Injuries at or below T12 level usually mean your bowel may not entirely empty, even when stimulated. The nerves between your bowel and spinal cord have been damaged, and the reflexes lost. Your rectum will continue to fill with faeces, which can leak out because the anal muscles stay relaxed.

Bowel management after SCI

After a spinal cord injury (SCI), individuals often face challenges with bowel management due to changes in bowel function and sensation. Here are some strategies commonly used for bowel management after SCI:

1. Routine: Establishing a regular bowel routine is crucial. This might involve setting specific times each day for bowel care to train the body to have bowel movements at predictable times.

2. Diet and Hydration: Maintaining a healthy diet high in fiber and drinking plenty of water can help regulate bowel movements and prevent constipation. Fiber-rich foods such as fruits, vegetables, whole grains, and legumes are beneficial.

3. Medications: Stool softeners, laxatives, or suppositories may be prescribed to help manage bowel movements and prevent constipation.

4. Digital Stimulation: Digital stimulation involves gently inserting a finger into the rectum and moving it in a circular motion to stimulate the bowel reflex and trigger a bowel movement.

5. Manual Evacuation: For individuals with limited sensation or mobility, manual evacuation may be necessary. This involves gently removing stool from the rectum using a gloved finger.

6. Enemas: Enemas can be used to stimulate bowel movements and help empty the bowel. These may be performed using water or a medicated solution.

7. Bowel Training Programs: Some rehabilitation centers offer bowel training programs that include education, training, and support to help individuals manage their bowel function more effectively.

8. Adaptive Equipment: There are various adaptive devices available to assist with bowel management, such as bowel management systems, bidets, and toilet seat risers.

9. Seeking Professional Guidance: It's important for individuals with SCI to work closely with healthcare professionals, such as doctors, nurses, or physical therapists, who specialize in spinal cord injury care. They can provide personalized advice and guidance based on individual needs and circumstances.

10. Monitoring for Complications: Individuals with SCI should be vigilant for signs of bowel complications such as bowel impaction, bowel obstruction, or autonomic dysreflexia, and seek medical attention if any problems arise.

It's essential for individuals with SCI to work closely with healthcare professionals to develop a personalized bowel management plan that meets their unique needs and helps maintain bowel health and function.

Why is it essential to carry out good bowel care after SCI?

Good bowel care is essential after a spinal cord injury (SCI) for several reasons:

1. Prevention of Complications: Individuals with SCI are at increased risk of developing bowel-related complications such as constipation, impaction, bowel obstruction, and autonomic dysreflexia. Proper bowel care helps prevent these complications, which can be painful, uncomfortable, and potentially life-threatening.

2. Maintaining Bowel Health: Regular bowel care helps maintain the health and function of the digestive system. Consistently emptying the bowel can prevent issues such as bowel distension, which can lead to long-term problems with bowel function.

3. Preventing Incontinence: Effective bowel management can help prevent episodes of bowel incontinence, which can be embarrassing and have a significant impact on quality of life. By establishing a regular bowel routine and managing bowel function effectively, individuals with SCI can reduce the risk of accidents and maintain dignity and independence.

4. Improving Quality of Life: Bowel care is an important aspect of daily living for individuals with SCI. By managing bowel function effectively, individuals can improve their overall quality of life, reduce discomfort, and increase confidence in daily activities.

5. Preventing Secondary Health Issues: Bowel dysfunction can have secondary effects on overall health, such as decreased appetite, malnutrition, and decreased mobility due to discomfort or pain. Proper bowel care helps prevent these secondary health issues and promotes overall well-being.

6. Reducing Healthcare Costs: Effective bowel management can reduce the need for medical interventions, emergency room visits, and hospitalizations related to bowel complications. By preventing complications, individuals with SCI can reduce healthcare costs and improve resource utilization.

Overall, good bowel care is essential for maintaining health, preventing complications, and promoting independence and quality of life for individuals living with SCI. It's important to work closely with healthcare professionals to develop a personalized bowel management plan that meets individual needs and preferences.