Neurogenic Bowel: What You Should Know. A Guide for People with Spinal Cord Injury

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2 Neurogenic Bowel: What You Should Know A Guide for People with Spinal Cord Injury

3 Why Is This Information Important? Before SCI, you didn t have to think about bowel movements After SCI, you may need more time, thought and planning for successful bowel movements You may not feel the sensation of needing to use the toilet You may need help expelling the stool

4 A Well-Designed Bowel Program Can Help By: Preventing unplanned bowel movements (incontinence) Minimizing constipation Putting you back in control of your body Improving your self-confidence and socialization

5 Talking about A Bowel Program Most consider talking about bathroom functions to be private and personal This will be a necessary challenge for many of you You will benefit by being an advocate for your needs Practice helps. The more you talk about it, the easier it gets Humor can relieve embarassment

6 What is the Bowel and Where is it? Everything you eat and drink travels through your digestive system (gastrointestinal tract, GI tract) The GI tract includes the mouth, esophogus, stomach, small intestine, large intestine (colon) and anus The colon is about 5 long Together, the large and small intestines make up the bowel

7 How Does the Bowel Work? Digestion breaks down food and liquid into nutrients your body can use Parts that can t be used by the body are eliminated as waste Undigested food moves through the small intestine and the colon Moisture is removed The remainder moves through the rectum and anus as it leaves the body

8 SCI Changes the Way the Bowel Works After SCI, the nervous system can t control bowel functions the way it did before Bowel movements are both reflexive and voluntary SCI can block messages from the digestive system to and from the brain SCI can keep you from feeling stool in the rectum and from controlling your anal sphincter

9 The Location of Injury Determines the Type of Bowel Pattern You May Have Reflexive Bowel (upper level SCI) Usually results from Cervical or Thoracic injuries Messages between the colon and the brain are interrupted Reflex Peristalsis (movement of matter through the bowel) still occurs Below the injury, bowel reflexes still function Stool buildup in the rectum can trigger a reflex bowel movement without warning

10 The Location of Injury Determines the Type of Bowel Pattern You May Have Areflexic Bowel (lower level SCI) This results from damage at the lower end of the spinal cord (lumbar or sacral) Peristalsis is reduced Reflex control of the anal sphincter is reduced You can t feel the need to have a bowel movement, and you can t empty the bowel on your own

11 What Is A Bowel Program? A total plan for regaining control of bowel function after SCI. Several things are involved, including: Diet and fluids Activity level Medications Bowel care

12 A Bowel Program Can Improve Your Quality of Life By Preventing or cutting down on bowel accidents Helping you eliminate enough stool with each BM at regular, predictable times Assuring that bowel care goes smoothly and is completed in a reasonable amount of time Keeping bowel-related health problems to a minimum

13 Digital Rectal Stimulation This relaxes and opens the external anal sphincter It also triggers peristalsis This is likely to be a part of your bowel program Staff will assist until you are independent with this Or, a caregiver will be taught to perform this as part of your bowel care program

14 Procedures for Bowel Programs DAY ONE: you may be Interviewed by rehab staff to determine your prior bowel routine After admit, the bowel program will be assessed and started. Depending on each individual the bowel program will begin on shower wheelchair or bedside commode or in a left side lying position OUR GOAL: Everyone will be able to successfully wear normal underwear and clothing before being discharged

15 Discharge Planning As soon as possible after admit and prior to DC, family members or caregivers are trained in the bowel routine Schedule of bowel program may need to be changed during your stay or you may want to change the time to better suit your needs at home Changing your time for a bowel program usually takes 3 cycles (3 bowel programs)

16 Bowel Programs for the Reflexive Bowel (upper level SCI) 1. Wash hands thoroughly 2. Position yourself. Transfer to a bedside commode or shower wheelchair. Keep your feet on a footstool with knees and hips flexed 3. Check for stool. Gently insert a gloved, lubricated finger into the rectum. Remove any stool that would interfere with inserting a suppository or mini-enema 4. Insert a stimulant suppository or mini-enema

17 Bowel Programs for the Reflexive Bowel (lower level SCI) 5. Waiting: Wait 15 minutes for the stimulant to work 6. Digital Rectal Stimulation a. Do this every 15 minutes for 3 cycles, until all stool has passed b. Recognize when bowel care is complete c. Do a final check with a lubricated, gloved finger d. You are finished if no stool has come out for 15 minutes or after three digital stimulations e. The rectum closing around the finger also indicates the bowel movement is complete

18 Bowel Programs for the Areflexic Bowel (lower level SCI) 1. Wash hands 2. Set up and positioning 3. With gloved and lubricated finger perform digital rectal stimulation and evacuation at 15 minute intervals 4. Use Valsalva maneuvers 1. Breathe in, try to push air out, block the air in your abdomen 5. Bend and lift if you have good torso stability. Changing positions helps expel stool 6. Check the rectum to assure it s empty 7. Wash and dry the anal area

19 Tips for A Successful Bowel Program Stick with a consistent schedule that works for you Choose a time that is convenient and where you will have privacy Try to do bowel care after a meal or hot drink Keep all supplies (lubricant, tissue, cloths, gloves) in a clean area where you will do your bowel program Keep a record of date, time, position, stimulation method, accidents, consistency, etc. Take good care of your skin. Use a padded chair. Don t sit on a broken vinyl surface Do pressure reliefs every 15 minutes while waiting

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