Neurogenic bowel management spinal injury guidelines

Bowel program spinal cord injury

After spinal cord injury one of the biggest challenge that one face is bowel movement. Bowel movement of a neurogenic bowel works in a different way after spinal cord injury and one need a lot of understanding and planning to manage it in good way.

To have good understanding of the whole phenomenon let us see how bowel movement works before and after spinal cord injury

Before spinal cord injury

When rectum of healthy person gets filled with stool, nerves in rectum sends messages to brain and one feel the urge to have bowel movement. If one finds a socially appropriate place and decides to have bowel movement then messages from brain travel through spinal cord to the bowel and sphincter muscle. The sphincter muscle relaxes and let stool pass through it. But if it is not proper time and place, brain tells the sphincter to remain close and hold the stool until one finds a proper place.

After spinal cord injury

After spinal cord injury as messages don’t flow from body to brain and vice-versa, due to blockage at injury site,  one faces a dilemma. Neither can one feel the urge to have bowel movement nor can one keep the sphincter close to prevent untimely stool passing through it. So a proper planning, thinking and timing is needed to prevent untimely passing of stool and to acquire bowel movement in a proper routine and time so that one can live a healthy and graceful life. This all process is known as neurogenic bowel management program.

Neurogenic Bowel

The uncontrolled bowel after spinal cord injury is known as neurogenic bowel. It has two types

1.Reflex bowel

In spinalcord injury above T12 the neurogenic bowel will be reflex bowel . Although signals from rectum do not reach the brain and one doesn’t feel the urge to have bowel movement but the spinal cord helps in bowel movement and passing stool by creating a reflex known as defecation reflex . After passing stool sphincter will stay  close. It is also called bowel movement in upper motor neuron.

2.Flaccid  bowel

If the injury is below T12 the defecation reflex is not produced and sphincter will not stay tight . Such kind of bowel is called flaccid neurogenic bowel. To prevent undesired and untimely flow of stool more planning and hard work is required in flaccid bowel.

What is a suppository?

Suppository is a very useful drug for bowel management after spinal cord injury. It is inserted in rectum and it works by stimulating nerves of rectum or drawing water into rectum and initiating stool passing. Usually after inserting it takes from 5 to 60 minutes to work. Different kinds of suppositories are available in market like glycerine suppository, Bullet suppository, Dulcolax suppository.

Digital bowel stimulation

Digital bowel stimulation is a very useful technique after spinal cord injury for starting bowel movement especially in upper motor neuron or reflex bowel. It start defecation reflex and open the anal sphincter for the stool to pass. Done by wearing gloves, lubricating finger and then inserting finger tip into rectum and then moving it in a circle. It is very useful for maintaining a good, short time and regular neurogenic bowel program.

Quadriplegic bowel management

Individuals suffering from quadriplegia should sit on commode chair every day or every other day. It doesn’t usually happens that stool will pass easily just after sitting on commode chair. Some techniques are required for it. As their neurogenic bowel is reflex bowel so defecation reflex can be stimulated through following techniques.

The first technique is the use of suppository. Suppository should be inserted before transferring to commode chair or after sitting on commode chair.

how long does dulcolax suppository take to work?

It will take from 5 to 15 minutes for the suppository to be effective and cause stool to pass.
Another useful method for quadriplegics to start defecation reflex and pass stool is digital rectal stimulation. As fingers of quadriplegics don’t work so an assistive device can be used for digital stimulation and to be independent in neurogenic bowel management program.

Paraplegic bowel management

Paraplegics with injury below T12 have flaccid bowel. So bowel management requires more efforts. Following steps should be taken for paraplegic bowel management.

• Try doing digital stimulation after sitting on commode chair.
• Use suppository.
• Do manual evacuation if both of the above fail.
• Take deep breath and hold the air inside after taking breath
• Move hand on your stomach clock wise from right to left.
• Lean forward and to the right and pick yourself up to change position of bowel and cause the stool to pass.

      Some common bowel issues

1. Spinal cord injury and constipation

As mobility is low for individuals carrying spinal cord injury so they often face problems of constipation. Some individuals deliberately try to create constipation to decrease bowel problems but it is not the solution at all and it increases problems. Constipation is really bad thing and  can cause various health complications. Spinal cord injury individuals should try hard to avoid constipation by increasing mobility, eating foods containing fibers and doing bowel management daily.

        2.Diarrhea

After spinal cord injury, diarrhea can make life very difficult. It not only causes neurogenic bowel accidents but  results in weakness due to emission of important electrolytes like sodium and potassium. It may be caused by excessive use of antibiotics or by consuming unhygienic food. Spinal cord injury individuals should try to consume less spicy and hygienic food.

       3.Bowel accidents

Neurogenic bowel accidents can make life miserable after spinal cord injury. It can be because of various reasons like not following a regular bowel program, diarrhea or constipation. To avoid bowel accidents try to follow a regular timely bowel management program and sit on commode chair after less intervals in case of diarrhea or constipation.

Read also: Bladder management in spinal cord injury

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