Bowel-related changes are common among victims with spinal cord injuries. Many spinal cord-injured clients have said that after the loss of mobility, loss of bowel control is the next most distressing aspect of SCI. These changes can affect your social, emotional, physical well-being, recreational and sexual function, and they can lead to life-threatening complications. However, bowel problems can be managed to prevent complications. Dr. Groah, a well-known physiatrist who specializes in spinal cord injury, helped our firm provide excellent advice and contribute to the issue of understanding bowel changes and spinal cord injuries.
Understanding Spinal Cord Injury Bowel Changes
Understanding the bowel changes you might experience helps to understand the digestive system. Your gastrointestinal tract includes your mouth, esophagus (swallowing tube), stomach, small intestine, and large intestine. Together, the small and large intestines make up your bowel. The digestive system breaks down food and liquid into nutrients for your body to use. Water and nutrients are absorbed back into the body and waste products are eliminated from your body in your stool.
For the most part, your body’s ability to absorb water and nutrients is unchanged because of your spinal cord injury. On the other hand, your body’s ability to move the stool through the colon and eliminate waste products from your body through a bowel movement is affected. Normally, when you feel stool in your rectum, you have the sensation that you will have a bowel movement. You squeeze the muscle called the “anal sphincter,” which functions to keep stool in your body.
Then, when you are ready to move your bowels, you relax the sphincter, and the stool leaves your body, resulting in a bowel movement. However, as we’ve learned already, sensation and muscle function (including the muscles around the anus) can change after spinal cord injury, and you may develop what doctors call a neurogenic bowel.
Your rehabilitation team may have suggested that you follow a bowel care program so that you can gain control of your bowel function again. The overall goal of your bowel care program is the safe, predictable, and efficient elimination of stool with few to no bowel accidents, which, in turn, will go far in preventing any other bowel-related complications.
What are the important components of a bowel care program?
Important components of a bowel care program are to:
Maintain a Consistent Schedule: This means following your bowel care program regularly and without failure, usually daily or every other day.
Find the “Right” Time During the Day: You may tend to have bowel movements more in the morning or at night. Listen to your body because it might be best to schedule your bowel care during those times.
Find the Best Position (Lying Down or Sitting Up): Gravity often helps move things along, so if you can, consider being upright for your bowel care.
Eat a Healthy Diet: Make sure you are getting enough fibre in your diet, and pay attention to foods or spices that disrupt your bowel care.
Drink Enough Water: Fluids help move things along, but you need to balance this with bladder management. Find out if you need medications and, if so, which one(s) work for you.
Learn the Right Way: You need to do manual evacuations of stool, digital stimulation, and put in suppositories and/or enemas.
Bowel care may not seem like the most important aspect of recovery after your spinal cord injury. Still, as time goes on, most people report that bowel and bladder function are sometimes more important to them than being able to walk. Also, bowel problems can cause social isolation and increase the need for assistance from others. People with SCI report that the three major bowel complaints are constipation, pain, and incontinence. So, as you follow your SCI, you will want to ensure that you take good care of your bowels to avoid these problems.
Finally, revisiting and reevaluating your bowel program periodically is always a good idea. Ask yourself the following questions:
- How long does my bowel care take – roughly more than one hour total or more than 30 minutes for a suppository to work is too long.
- Are you having bowel accidents? More than a rare accident is too many.
- How often are you emptying your bowels? Don’t get lazy with those bowels. Most people need to do this at least two to three times per week.
- Do you have pain and/or bleeding from hemorrhoids? This might be due to constipation.
- Are you constipated? Signs of constipation can include bloating, pain, mucous leaking from your rectum, and long delays in your bowel care regimen.
- Are you taking other medicines that might affect your bowel care? These medicines might include painkillers and antibiotics.
- Are you satisfied with your bowel care program? If not, call your SCI specialist to discuss things you can do differently. Even though you may be satisfied with your bowel care program at some point, it may slowly change over time.
Ask yourself these questions above every so often to head off small problems before they become larger ones. Because of the impact that bowel problems have on people after SCI, researchers are currently conducting experiments in which electrodes are implanted around the nerves controlling the bowel and bladder so that you can push a button on a remote control to cause you to have a bowel movement or empty your bladder.
What about colostomy?
Sometimes, either immediately after SCI or even years down the road, you may hear about a colostomy for bowel care. “Ostomy” means an artificial or surgically created opening from the urinary or digestive tract to the outside of the body. A “colostomy” is either a temporary or permanent opening made by a surgeon in which a portion of the large intestine, or colon, is brought to the skin of the abdomen, forming an opening through which stool passes. The stool is then collected on the outside of your abdomen in a collection bag hidden by clothing.
Having a colostomy sometimes makes what has been difficult bowel care easier because there is no need to insert a suppository, perform digital stimulation, or sometimes wait hours for a bowel movement. Some recent studies have shown that people with long-term SCI who choose a colostomy are satisfied and report that their quality of life has improved as a result. If you feel that you’ve tried everything (changing the time, frequency, position, diet and fluids, medications, etc.), you may want to speak with your healthcare provider to see if a colostomy is a good option for you. Also, it’s always helpful to talk with other people living with a colostomy to find out what it’s like.
Have you or a loved one suffered a spinal cord injury as a result of the negligence or carelessness of another person?
Remember, the cost of living with living with a spinal cord injury can be an enormous burden on the victim and his/her family. It’s important to have the resources necessary to obtain proper equipment, rehabilitation, training, services, and other items necessary to achieve personal goals and enhance and maintain a satisfying quality of life. In addition, although your family members may now choose to help you and provide personal care support, the long-term availability of appropriate care cannot be guaranteed and is essential for your health and well-being to plan financially for your future.
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