After a spinal cord injury (“SCI”) or illness, a person is faced with many challenges and changes, including to their bowel routine and care. A bowel care program is necessary to maintain overall health and wellness and achieve the highest quality of life.
Neurogenic bowel is the loss or absence of bowel or normal intestinal function due to SCI or illness. Neurogenic bowel diseases can happen after damage to the bowel’s extrinsic neurological control. Diagnostic groups at risk for neurogenic bowel include:
- Spinal cord injury
- Multiple sclerosis
- Spina bifida
- Long-term care
- Traumatic brain injury
SCI disrupts how the bowel system sends signals to the brain about when stool needs to be emptied.
Spinal cord disorders are classified by neurological level (anatomic level) and by the degree of intactness of ascending and descending spinal cord pathways (“complete” or “incomplete”). All people with complete SCI have neurogenic bowel, and most people with incomplete SCI have some degree of bowel dysfunction.
The degree of bowel function varies depending upon the spinal cord injury’s disorder, damage, and completeness.
Reflexive or upper motor neuron (“UMN”) bowel results from paralysis that damages the nerves that control the bowel.
Areflexic or lower motor neuron (“LMN”) results from a spinal cord injury below T-12, thus damaging the defecation reflex and relaxing the anal sphincter muscle.
If the injury is above T-12, there is a loss of the ability to sense a full rectum, and the anal sphincter remains tight, causing bowel movements to occur on a reflex basis. When the rectum is full, the defecation reflex will occur. Loss of sphincter control can result in an inability to have a bowel movement and can lead to impaction, which can be serious.
The best way to manage this is to have an effective bowel management program and ‘train’ your bowels to ‘go’ on a more predictable and manageable basis.
A bowel program for neurogenic bowel should be designed to consider the type of neurogenic bowel, attendant care, personal goals, life schedules, employment, and quality of life.
Bowel programs should be initiated during acute care and continued throughout life unless full recovery of bowel function returns. Careful measures must be taken to avoid pressure ulcers and falls.
In addition to the risk of physical complications, social and emotional support should be available to help individuals manage the mental health impact of neurogenic bowel.
Effective treatment of common neurogenic bowel complications, including fecal impaction, constipation, and hemorrhoids, is necessary to minimize potential long-term complications.
Hydration: Staying hydrated is vital to both a bowel and bladder management program. Adequate non-diuretic fluid intake helps keep stool moving through the gastrointestinal tract and reduces the risk of constipation. Drinking two or more quarts of water a day is ideal.
Eat Fiber-Rich Foods: Consuming fiber-rich foods is one of the most important things you can do to manage your bowel care. Foods high in fiber include chickpeas, legumes, raspberries, broccoli, kidney beans, split peas, pears, avocado, and even dark chocolate. Sugar, caffeine, unhealthy fats, and sodium take a toll on overall health and do not promote healthy bowel movements. Keep unhealthy foods and beverages to a minimum, or even better, eliminate them!
Follow a Regular Schedule: Following a regular bowel management program “teaches” the bowel when to have a movement. Bowel programs typically require 30-60 minutes to complete. Gravity can assist with bowel movements, so if a seated position on padded or inflatable seats is possible, this can be helpful.
Evaluate Medications: Certain medications can affect the bowel and cause obstruction or constipation. Anticholinergics, antidepressants, narcotic pain medications, and spasticity drugs are some examples.
Range of Motion Exercises: Physical movement also helps stimulate the bowel. Stretching and range of motion exercises help keep a regular bowel routine.
Medical and surgical options are available to treat neurogenic bowel if diet, lifestyle, and bowel management program changes are ineffective, including minimally invasive options.