Introduction To Spinal Cord Injury →
Bowel Management →
Bowel Management Program
5.2. Bowel Management Program
With a spinal cord injury, you will need to train your bowels to have a bowel movement at the time you want.
Each person's bowel program should be individualized to fit his/her own needs. The type of disease or nerve damage should be taken into account as well as other factors. Components of a bowel program can include any combination of the following methods:
1. Manual Removal- Physical removal of the stool from the rectum. This can be combined with a bearing down technique called a valsalva maneuver (avoid this technique if you have a heart condition)
2. Digital Stimulation – Circular motion with the index finger in the rectum, which causes the anal sphincter to relax
3. Suppository - Dulcolax (stimulates the nerve endings in the rectum, causing a contraction of the bowel) or glycerine (draws water into the stool to stimulate evacuation)
4. Mini-enema – Softens, lubricates, and draws water into the stool to stimulate evacuation
What to do if...
Stool is too hard (constipation)
– Add or increase the dose of a stool softener (such as colace) or psyllium hydro-mucilloid (such as Metamucil or Citrucel). Increase your fluid intake and dietary fiber. Increase your activity level. Avoid foods that can harden your stool, such as bananas and cheese.
Stool is liquid or runny (diarrhea)
– Temporarily discontinue the use of any stool softeners. Try adding or increasing the dose of psyllium hydro-mucilloid (Metamucil, Citrucel), which adds bulk to liquid stool. If diarrhea persists for more than 24 hours or if you have a fever or blood in your stool, consult your health care provider. A frequent cause of diarrhea is a blockage or impaction of stool (liquid stool leaks out around the blockage). If you suspect impaction, consult your health care provider.
Frequent bowel accidents
- Be sure your rectum is completely empty at the end of your program. Increase the frequency of your program (some people with a flaccid bowel may need to empty their bowels twice daily). Try using only half of a suppository. Evaluate stool consistency — if it's too hard or too soft, see above. Monitor your diet for any foods that may over stimulate your bowel, such as spicy foods.
- If you notice a clear, sticky, sometimes odorous drainage from the rectum, try switching from a suppository to a mini-enema, or using only half of a suppository, or try eliminating suppositories or mini-enemas completely and begin your program with digital stimulation only.
No results in 3-4 days
– Treat constipation as recommended above. If there are no results in three days, try Milk of Magnesia or a single dose of an herbal laxative at bedtime. Do your bowel program in the morning. If there are still no results, repeat the dose of Milk of Magnesia or herbal laxative the next evening. If there are no results in the morning, consult your health care provider.
– Keep your stool soft. Be very careful to do digital stimulation gently and with sufficient lubrication, and keep your fingernails short. If you have known hemorrhoids, you may treat them with an over-the-counter hemorrhoidal preparation. If bleeding persists or is more than a few drops, consult your health care provider.
– Increase the frequency of your bowel programs. Avoid gas-forming foods, such as beans, corn, onions, peppers, radishes, cauliflower, sauerkraut, turnips, cucumbers, apples, melons and others that you may have noticed seem to increase your own gas. Try simethicone tablets to help relieve discomfort from gas in your stomach.
Bowel program takes a long time to complete
– Try switching from a suppository to mini-enemas. Increase your intake of dietary fiber and add or increase the dose of psyllium hydromucilloid. Try switching your program to a different time, and be sure you schedule it after a meal to help increase intestinal peristalsis.
Autonomic dysreflexia during bowel program
– Use xylocaine jelly (available by prescription from your health care provider) for digital stimulation. You may also need to insert some of the jelly into your rectum before beginning the program. Keep your stool as soft as possible. If dysreflexia persists, consult your health care provider. You may need medication to treat or prevent this condition.
In managing your bowel program, it is recommended that you avoid regular use of stimulant laxatives, full-size enemas, skipping or changing your program, rushing though your program, and more than four digital stimulations at a time. Also, the more active you are and the more liquids you drink, the easier it is for food to travel through your digestive system. Foods high in fiber will help control your bowels and will prevent constipation. Try to limit spicy foods, greasy foods, and "junk" foods and include more fruits and vegetables in your diet.