Bowel Care
Just like bladder care, it is important to establish a regular daily routine to maintain your health and wellbeing.
Immediately after a spinal cord injury your bowels will be ‘flaccid’, i.e., lack muscle movement. However, your bowels will continue to process food and absorb nutrients. Following an injury, you will need to learn new and different ways of managing your food intake and bowel movements.
How you manage your bowel care after your injury depends on the level of your injury and whether you have a Reflex Bowel or Flaccid Bowel.
What is a Reflex Bowel?
If your injury is above T12-L1 it’s likely your bowel will empty by a reflex action. This means when your bowels are full a signal will be sent up your spinal cord and back to the sacral nerves and anal sphincter muscles. The signal tells the rectum to squeeze and the anus to relax. This is when you would have a bowel motion.
What is a Flaccid Bowel?
If your injury is T12-L1 or below, you’ll likely have a flaccid bowel. This means the anal sphincter muscles that normally keep the anus closed becomes relaxed and stays open. People with flaccid bowels have very limited if any control over when their bowel empties.
The Importance of a Bowel Routine
Bowel routines help train your body on when to ‘go’. The goal of establishing a routine is to provide you with more freedom, control and predictability. This is done by:
- Passing a stool on a daily or every-other-day basis (The goal is to pass a stool around the same time each day).
- Preventing unplanned bowel movements
- Emptying all or most of your rectum each day
- Having stools that are soft, formed, and bulky
A successful bowel program will come down to diet, timing, medicines, and techniques. Regular bowel routines often are interrupted when people travel, go into hospital or stay in unfamiliar surroundings (visiting friends and loved ones).
Diet and Fluids
A balanced and a high fibre diet will be important in establishing a routine and of course for your health and wellbeing. A healthy and balanced diet will help your bowel routine in numerous ways, including:
- High fibre diets bulk out stools – making it easier to pass through the colon
- Fruits, vegetables and nuts are great natural sources of fibre. You could also consider introducing fibre supplements.
- Drinking plenty of fluids will reduce your risk of constipation
- Avoid highly caffeinated drinks like coffee, tea and energy drinks which dehydrate
Timing
Establishing a consistent and predictable routine for your bowel is a very important step towards independence. You will need to follow your bowel routine each day around the same time. The more regimented you can be, the more likely it is that your body will adapt and follow the routine.
Medicines
Your doctor may prescribe you laxatives to promote a regular bowel routine. Some common laxatives are:
- Stool softeners to make stools soft and easy to move through your colon
- Stimulant laxatives that promote movement within your colon
- Bulking laxatives to add shape and form to your stools and prevent diarrhea
- Rectal laxatives to help with rectal movement and emptying
While these medications promote bowel movement, you may also be taking medications that cause constipation. You may already be taking these medications, or it could be introduced to your diet later. Some medications that can cause constipation include:
- Pain medication, such as hydrocodone, oxycodone, morphine, fentanyl, gabapentin, pregabalin, or carbamazepine
- Muscle relaxant, such as cymbalta, sertraline, or citalopram
- Medication for your mental wellbeing, such as cymbalta, sertraline, or citalopram
When you are visiting your health professional and are prescribed medications, you should remind them of the need for you to maintain a regular bowel routine.
Techniques
There are a few techniques that you can introduce to promote a regular bowel routine. These techniques include:
- Rectal stimulation – moving your fingertip in gentle circular motions around the anus. This motion stimulates the anus and encourages emptying of bowels.
- Physical removal of stool – using fingers to physically remove the stool from the rectum to speed up emptying.
- Enemas – this device flushes warm water into your anus which helps to empty the bowel.
Following a regular bowel routine will go a long way for your health and wellbeing. Having a regular bowel routine will help avoid more serious problems down the track, plus it will give you more predictability and control so you can focus on getting on with your day.
Some individuals with spinal cord injury may have received specialist medical recommendations to best manage faecal output by having a surgical procedure to enable the use of a ‘Stoma’ or bag that adheres to the abdomen. In this case, faecal matter doesn’t travel through the bowel to exit the body but instead is gathered in a stoma bag that is stuck to the abdomen. Many individuals live a meaningful life after this surgery, and sometimes people choose this surgery in consultation with their health professionals.
There are many factors involved in good bowel care, especially the establishment and maintaining of a routine. For further support our team of Community Nurses can assist you.
Contact us today to find out more.
