Digestive system

Bowel Management Following a Spinal Cord Injury

Neurogenic bowel is a common symptom associated with spinal cord injuries and it will usually require careful maintenance. Bowel management issues can be effectively managed and good bowel health can be maintained following a spinal cord injury.

Issues following a Spinal Cord Injury

Spinal cord injuries have the potential to impact several parts of the body. Whilst lack of mobility and reduced or loss of sensation are two of the primary symptoms that come to mind with this type of injury, there are many other bodily functions that can also be affected.

It’s not uncommon for individuals with spinal cord injuries to have issues with bladder management, sexual function and also high blood pressure.

Here we look at neurogenic bowel management issues that can occur following a spinal cord injury, including the challenges that individuals face and the measures that can be put in place to help alleviate some common problems.

How the Digestive and Bowel Systems Typically Work

How we digest food and get the nutrients we need is one of the most intriguing areas of human biology. The digestive system essentially consists of a long, hollow tube that begins at that mouth and throat and ends where we excrete waste at the anus.

The bowel is the last step at the end of the digestive tract, an area of the body which essentially holds waste matter until we’re ready to get rid of it. As food travels to the bowel, nutrients are extracted through the lining of the digestive tract and transported via the blood vessels around the body.

Food is transported along the tract by a series of gentle muscle movements called peristalsis. This consists of muscles contracting and relaxing until the digested food reaches the colon.

This is controlled by the vagus nerve and it’s the relationship between the brain and our nervous system that decides when it is time to eliminate waste from the body. When we’re ready, messages from the brain are sent via the spinal cord to relax the pelvic floor and initiate defecation. 

Paralysis and How it Affects the Bowel System

Neurogenic bowel dysfunction can be caused by a spinal injury and there are two types depending on where damage occurs.

Upper Motor Neuron (UMN) bowel dysfunction occurs when there is damage above the conus medullaris at L1 or the upper lumbar region.

This causes issues by not allowing the anal sphincter to relax. It can lead to waste matter being retained for too long, causing constipation and dry stools. The reflex of elimination, however, does remain which means that activity can be stimulated by inserting something into the anus or applying a mild electric impulse.

Lower Motor Neuron (LMN) bowel dysfunction occurs with damage below the L1 level. This can cause impairment of peristalsis which means stools cannot be moved and there is a risk of both incontinence and constipation.

Management of Bowel Issues Caused by a Spinal Cord Injury

Mini enema
A mini enema can be used to help stools to pass

Most of us can decide when we are going to empty our bowels. Unfortunately, bowel movement problems are not uncommon for those with spinal cord injuries. Putting in place a program to manage going to the toilet is the most appropriate action to take.

Bowel care following a spinal cord injury depends on a range of different factors, including where the injury occurs and the severity of the damage. Individual bowel programs need to be developed and no one person is the same. A program may include:

  • Physical removal of fecal matter from the rectum. This can be helped by incorporating the Valsalva Maneuver, which involves altering breathing to increase pressure on the chest, which in turn increases colonic pressure and helps induce a bowel movement.
  • Digital stimulation can also be used to relax the sphincter muscle and induce a bowel movement. A similar effect can be produced by using a suppository such as Dulcolax which acts to stimulate the nerves in the rectum and elicit a contraction of the bowel.
  • A common solution is a mini-enema that delivers water into the stool, lubricating it in preparation for evacuation.

Another factor in creating a bowel movement program is the timing of the process. If a suppository is being used, it can take fifteen to twenty minutes to work. There then follows a period of digital stimulation to encourage the bowel to evacuate. The whole process can take between 30 minutes and one hour to complete.

Other things to take into consideration may be the positioning of the individual during a bowel movement. Some prefer to be lying down while others might want to use a commode. Whether someone is able to relax can also have an influence.

The individual’s diet and the amount of fluids they consumes will also play a role in the ease of their bowel movements – so it’s important that good nutritional advice is considered at all times.

Finding the right balance is a case of trial and error for most individuals who have neurogenic bowel and patience, in the beginning, is certainly required.