Bowel Management

How the bowel normally works?

The food that you eat passes from your mouth, down your oesophagus and into:-

  • In the stomach. Here the food is mixed and broken down into a thick fluid that can be absorbed by your body.
  • The fluid leaves the stomach and passed through the small and large intestine.  As it passes through, nutrients and water are absorbed, so that by the time it reaches your rectum it is usually quite solid.
  • This solid matter (also called faeces or a stool) is then expelled through your anus

Usually when the rectum is full a message is sent to the brain via the spinal cord.  The brain sends a message back and if convenient, your abdominal and pelvic muscles contract and you empty the rectum.

How does a spinal cord injury affect the bowel?

In nearly all cases of spinal cord injury there will be some impact on your bowel function:

  • The messages that travel up and down the spinal cord to and from the rectum will be interrupted.
  • You may be unable to strain to expel the faeces.

So, your bowel must be trained to empty completely on demand.

What are the main factors in bowel management?

Bowel training and management revolves around:

Diet

  • Well balanced, high fibre diet
  • Plenty of Fluids – mainly water but after 3 litres of water, a drink with supplementary electrolytes such as Gatorade or Powerade should be taken, as otherwise the body fluids become too diluted, causing weakness and drowsiness.
  • Healthy eating

Medications

Four main aims: -

  1. “bulk” to assist the poor western diet in which much of the fibre has been reduced – e.g. metamucil, normacol, etc.,
  2. Lubrication – to assist solid matter to move through the bowel – e.g. Duphalac / Actilax etc – or paraffin oil (even “Para-Choc”) – to make passage of waste matter through the poorly contacting bowel, easier
  3. A “pusher” – tablets that make the bowel contract to push faecal matter through the bowel to the rectum for evacuation
  4. A low evacuant” – medication to make the lower part of the bowel (rectum), contract to allow faeces to be expelled – microlax / bisalex enemas or suppositories.

Sometimes the whole contents of the bowel are not emptied and precede severe constipation. Treatment should be supervised by a Doctor as otherwise severe dysreflexia can occur. Often the treatment will consist of:-

Colonlytely 1 litre 12 hourly (or more, if supervised by Doctor) may be needed to break up very hard faeces and allow bowel emptying.

Time and routine

  • Having your bowel routine at the same time each day and / or every second day will ensure complete emptying and reduce the likelihood of accidents.
  • If you change your routine it may take 2-3 weeks for your bowel to adjust.

Tips for effective bowel emptying? :

  • A meal or hot drink beforehand will stimulate you bowel to move and empty the rectum.
  • Sitting up over the toilet or in your shower chair for about 30-45 minutes will promote gravity and assist with emptying.
  • Massaging your abdomen and doing some deep breathing may help.
  • Passive and active exercise can also help stimulate your bowel to move.

Help is available for problems with:

  • Diarrhoea
  • Constipation
  • Rectal bleeding
  • Autonomic dysreflexia