Bowel Care

A spinal cord injury (SCI) generally affects the process of eliminating waste from the intestines. This can result in a:

• Reflexive bowel, which means you cannot control when a bowel movement occurs.
• Flaccid bowel, which means you cannot have a bowel movement. If stool remains in the rectum, mucus and fluid will sometimes leak out around the stool and out the anus (fecal incontinence).

You or a caregiver can manage both of these types of bowel problems to prevent unplanned bowel movements, constipation, and diarrhea. Although this often seems overwhelming at first, knowing what to do and establishing a pattern makes bowel care easier and reduces your risk of accidents.

When choosing a way to deal with bowel problems, you and your rehabilitation (rehab) team will discuss such factors as the type of bowel problem you have, your diet, whether you or a caregiver will do the program, and any medicines that may affect your program.

Bowel programs

For a reflexive bowel, you usually use a stool softener, a suppository to trigger the bowel movement, and/or stimulation with your finger (digital stimulation). There are many stool softeners and suppositories available. You will have to experiment to find the one that works best for you.

For a flaccid bowel, you usually use digital stimulation and manual removal (disimpaction) of the stool. At first, you do this program every other day. Later, you may need to do it more often to prevent accidents. You may also have to adjust how much and when you eat.

For some people with SCI, eating more fiber can help with managing their bowel habits. Good sources of fiber include whole-grain breads and cereals, fruits, and vegetables.

For best results:

• Do your program at the same time every day. Most people do their bowel program in the morning, although you should pick the most convenient time. After you have picked a time, stay with it.
• Sit up if possible. This can help move the stool down in the intestine. If you cannot sit up, lie on your side.

It is important that you practice cleanliness and be gentle while inserting anything into the anus.

• Always wash your hands and use gloves. Lubricate the finger of the glove with K-Y jelly or a similar product.
• For digital stimulation, gently insert the finger in the anus and move it in a circular motion for no more than 10 to 20 seconds every 5 to 10 minutes until you have a bowel movement.
• To remove stool, gently insert the finger and remove stool. Continue to do so until none comes out. Wait a few minutes and then try again to see if any more stool has moved down.
• To insert a suppository, first remove stool. Otherwise, the suppository will not work. Take the wrapper off the suppository and insert it as high as you can.

  See a picture of inserting a suppository.

Note: Bowel problems can trigger autonomic dysreflexia, a syndrome in which there is a sudden onset of very high blood pressure and headaches. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. Although autonomic dysreflexia rarely leads to these more serious complications, it is important to know the symptoms and watch for them. Autonomic dysreflexia is more common in people with an injury to the thoracic nerves of the spine or above (T6 or above).