Without the recommended fluid, the bulk fiber becomes extremely hard in the stool which creates impaction, stool that is difficult to pass, and stool that has rough edges which can tear or cut the bowel or anus.
Individuals who monitor their fluid intake or have health conditions that limit fluid intake such as heart conditions or extreme edema cannot take in the recommended fluid amounts.
Others have not been educated about the eight ounces of fluid needed. They may have even received a low fluid amount in a health care setting which makes individuals feel that the total amount of fluid is not required.
If you have an areflexic LMN neurogenic bowel or other bowel condition and are taking a bulk fiber laxative with the proper amount of fluid that is providing moist assistance to your bowel program, be sure you are using products with no added sugar.
A secondary complication of spinal cord injury and other neurological disorders is adult-onset diabetes. The extra sugar can add to your risk of developing or affecting diabetes. Check with your health professional to see if you should still be taking a bulk fiber laxative product.
You may find it is working against your bowel program goals or that another product will better suit your needs. Enemas can damage fine fibers in the bowel that move the stool forward and out.
The unpredictability of the product, washing away of the healthy bacterial flora, and reduction in bowel peristalsis make these products too unpredictable for use. Individuals can become reliant on laxatives for bowel movements regardless of their health condition. When this occurs, a bowel movement will not happen without the laxative which can make a bowel movement even more difficult to accomplish. What seems to be helping in the short term will lead to serious complications in the long term.
Be sure you discuss each product with your healthcare professional. Sometimes a natural product is actually a laxative, diuretic or can interfere with other medications. Many of the clerks in the health store are knowledgeable about their products but some have a limited knowledge about health needs and are not versed in neurogenic bowel issues.
Be sure you speak with an informed healthcare professional prior to embarking on a bowel regimen that may not be to your advantage. Therefore, they should not be recommended on an ongoing basis. Recommendations are for use with antibiotic associated diarrhea and Clostridium difficile C.
Surgical options may be considered for individuals who face challenges with neurogenic bowel programs. Some individuals think that a surgical alternative would be a better choice because they do not like the idea of performing the bowel program or it takes too much time or any of a variety of valid reasons.
The goal of the bowel program is to have your bowel function in its natural way. Surgical decisions should be carefully considered. MACE is a surgical procedure where the appendix is connected to a permanent opening to the abdominal wall. A catheter is used to irrigate the bowel and rectum for waste removal. Advantages include no bag for collection and little leakage.
Complications can include stomal stenosis, stomal site infection, possible leakage through the stoma, and difficulty with stomal catheterization. Not many are aware of this procedure. It has a high success rate with improvement in quality of life and reduction of autonomic dysreflexia AD episodes. A colostomy is a surgically created artificial opening in the abdomen where the large intestine of the bowel is then connected.
Stool is excreted through the opening. A bag is taped to the skin around the opening to collect the stool. As with any surgery, colostomy surgery can be dangerous for an individual with neurological issues especially due to respiratory complications. Be sure to evaluate the risks vs.
It can be more difficult to maintain a colostomy than to perform a bowel program. Changing bags, bags falling off or bursting, irrigation of the colostomy are just a few of the issues that can arise. Colostomy bags can be difficult to secure to the abdomen. The brochure makes bag use look easy, but colostomy bags work best on a muscular abdomen. Securing a colostomy bag on the typical abdomen can be a challenge. Not all health payors will finance the supplies and care for a colostomy which can be expensive.
Investigate costs and payor resources prior to making this financial responsibility. Elective colostomy allows placement options. Closer to the end of the large intestines will result in expulsion of stool-like contents. The farther up the large intestine, the looser the stool will be. Individuals have preferences about colostomy location by stool type and convenience. A Physiatrist is a physician who has advanced education in physical medicine and rehabilitation needs. Some have specialty areas in brain injury or spinal cord injury, but all will be able to assess and prescribe rehabilitation techniques as well as to problem solve issues.
Rehabilitation nurses provide instruction and care of individuals with neurogenic bowel. They have an extensive knowledge of how to perform the bowel programs as well as problem solving.
A Gastroenterologist is a physician who will be able to assist with testing, diagnosis, and treatment of neurogenic bowel as well as other issues that can arise in the gastrointestinal GI system.
This can include surgery for hemorrhoids, fissures, fistulas, rectal prolapse, MACE and colostomy. A Registered Dietitian assists with education about planning food choices that will make your bowel management a success.
The Physical Therapist provides therapy and instruction for toileting transfers, muscle strengthening, electrostimulation, and movement. The Occupational Therapist can assist with bowel management program design. They are resources for adaptive equipment such as suppository insertion, digital stimulation, electrostimulation, and commodes. Dentists keep your teeth and mouth in good condition to ensure an effective start to the digestive process.
Individuals with neurogenic bowel are not exempt from common bowel issues. These bowel concerns may impact your health in addition to the effects of neurogenic bowel. Digestion and bowel function rely on the entire digestive system or gastrointestinal GI tract working well. Any issue at any point in the processing of food and fluid can affect bowel management.
Therefore, it is important to review all phases of digestion to create an environment in your body to improve bowel function. People often just think about the output of the bowel as affecting function, but a disruption anywhere along the GI path can affect output. Be sure you are smelling, seeing, and tasting food. If any or multiple senses are not functioning correctly, your enjoyment of food will be reduced. Your healthcare professional can easily test your senses in a medical office by assessing your cranial nerve function.
If there is a concern with any of your senses, you may be referred for further testing using MRI or CT scans to look for the source. Teeth are critical to be able to chew food.
Chewing is the first step in breaking food down so it can be further manipulated by the stomach. Chewing foods into smaller particles allows more surface area for saliva and stomach acids to create small particles for digestion. The less chewing, the more work is placed on the stomach or even the small intestine to extract nutrients from food.
Too large of particles will not be able to be extracted and can pass through the bowel still intact. Good dental care is important to eating. This can prevent loss of teeth, dental caries cavities and sores in the mouth.
Be sure to do your part to keep your mouth clean and free from food particles which can lead to pneumonia if inhaled or contribute to dental decay if left in your teeth.
Adaptive equipment can assist you with your dental needs such as handcuffs for holding toothbrushes, dental floss on a toothbrush style handle and toothbrushes that attach to suction machines. Swallowing should be assessed if there is an issue prior to putting food or fluid into the mouth.
A swallow study may be done to ensure swallowing is safe and that there is no leaking of food or fluid into the lungs. Simple swallow assessments can be performed at the bedside, but more definitive studies are done in healthcare settings by educated professionals using multiple textures and fluorescence X-ray to view your internal swallowing ability.
Mouth sores or discomfort can lead to pain which makes individuals slow or even stop eating and drinking. They can reduce the taste of food or even make it taste bad. There are several conditions that affect the mouth and thus the ability to eat.
Most of mouth symptoms are sores, blisters, red spots, pain and swelling. Treatment is based on the cause.
These conditions include:. Stomach contents can back up into the esophagus which can irritate and stretch esophageal tissue. This can be unnoticeable or with symptoms of coughing or a burning sensation typically called heartburn. If this is progressive, gastro esophageal reflux disease GERD is diagnosed. Over the counter and prescription medication are usually suggested. Sleeping with the head of the bed elevated or the head of the bedframe on risers may also help.
Continued reflux should be examined to ensure the esophagus is free from erosion, ulcers, and cancer. Upset stomach is called dyspepsia.
If you have an intermittent or continual dyspepsia, you will need to be assessed for issues that can be affecting the lining of your stomach which would slow the digestive process. Stomach lining issues can lead to slow digestion or scarring of the muscle tissue.
These concerns may include gastric ulcer stomach ulcer , peptic ulcer disease, gastritis inflammation of the stomach , stomach cancer, gastric varices enlarged veins , or stomach bleeding. Gastritis is an inflammation of the stomach that can be from many causes--one is from a bacterium, H. Medications to reduce stomach acid production or to treat infections are typically prescribed. Occasionally, surgical repair of ulcers is needed.
Gastroparesis is a condition of the stomach where gastric emptying is delayed. Medication can help increase stomach actions. Upper endoscopy esophagogastroduodenoscopy or EGD : A tube that is passed through the mouth into the esophagus, stomach, and duodenum to visually examine the tissue. A biopsy of the esophagus or stomach can be made at this time. Barium swallow: A solution that can be used with X-ray is ingested followed by images of the upper digestive system to look for issues or concerns like ulcers or other problems.
Issues in the intestines are numerous. Any concern with the intestines can affect movement of chyme through the bowel either too quickly or too slowly. Common bowel issues are:. Many treatments for the intestines are provided by use of over the counter and prescription medications to speed or slow the bowel.
Antibiotics are given for infection. Treatment of bowel conditions depend on extent of the issue. They are often done during a colonoscopy procedure or with surgery. Assessments of the intestines include:. Colonoscopy is a commonly performed test of the intestines. A tube is inserted into the rectum. The entire colon can be visually inspected. Biopsies can be done. Polyps and small tumors can be removed. X-rays can be taken.
If just the lower colon is viewed, the test is called a sigmoidoscopy. Prior to colonoscopy testing, an extensive bowel prep or cleanse is performed. Individuals with spinal cord injury may be able to be admitted to the hospital for the bowel prep. Check with your payor.
There are several issues that can occur in and around the rectum as this is the last section of the digestive tract within the body. Assessment and treatment of rectal issues is done by physical assessment through visualization of the rectum, a digital examination, an anoscope or a sigmoidoscopy.
Treatment can include antibiotics for infection, medical treatment, or surgical intervention. It is recommended that individuals with neurological issues who require advanced treatment for hemorrhoids have conservative procedures rather than surgical excision.
Better understanding of how the digestive system works specifically in nerve related issues of the bowel is being heavily researched. This includes bowel function, nervous system function, drug responses, and improvements in bowel management procedures. Quality of life due to alterations in bowel function drives many of these studies to improve life satisfaction for individuals with neurogenic bowel.
Research has enhanced care for individuals with neurological injury. If muscles are stimulated with electrical medical devices, these are used to enhance function and recovery. This treatment is used for individuals with reflexic UMN injury. For individuals with areflexic LMN injury, functional electrical stimulation can be used at the zone of transition to strengthen muscles which results in increased function and with peripheral nerve stimulation especially for bladder and bowel control and sexual function in males.
Implants of functional electrical devices are available in research settings but soon to be available in general. Opportunities for this type of treatment will become more common as progress is occurring rapidly. This will create a huge opportunity for reduction of secondary complications of spinal cord injury as well as enhancing function and even recovery.
Significantly, nerve rerouting procedures to peripheral nerves to improve function and avoid complications are available. Many research studies are being conducted to better understand neurotransmitters especially glutamate and acetylcholine, scaffolding which allows transplanted nervous tissue or stem cells to remain in the area of neurologic injury as well as disease specific studies.
This is a time of major leaps in neurological research and treatment. Not as quickly as we would all be desiring but in scientific time, a huge leap. Researchers are especially keen to understand fetal and early development to be able to harness the rapid growth of the nervous system to treatment options. This is another way science is seeking to improve the lives of individuals with neurological issues.
The number of individuals with neurogenic bowel dysfunction is unknown as there is no central collection repository.
Estimates of neurogenic bowel by disease or injury varies by source. Many common diagnoses do not have reports of prevalence of neurogenic bowel.
Some diagnoses with averages of reports of neurogenic bowel are:. Bowel care is very personal! This video highlights how a person with a spinal cord injury at C7 uses adaptive equipment to perform his own bowel cares.
These items can be found online or with the help of an occupational therapist. If you are looking for more information about bowel management or have a specific question, our Information Specialists are available business weekdays, Monday through Friday, toll-free at from am to pm EST. Additionally, the Reeve Foundation maintains a bowel management fact sheet with additional resources from trusted Reeve Foundation sources.
Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.
We encourage you to reach out to support groups and organizations, including associations which feature news, research, resources, national network of support groups, clinics, and specialty hospitals.
Bowel Management booklet. Written for health care practitioners. Spina Bifida Association. Guidelines for the Care of People with Spina Bifida. Ambartsumyan L, Rodriguez L. Bowel management in children with spina bifida. J Pediatr Rehabil Med. PMID: Awad RA. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease.
World J Gastroenterol. Diet in neurogenic bowel management: A viewpoint on spinal cord injury. Effect of sacral neuromodulation on bowel dysfunction in patients with neurogenic bladder. Colorectal Dis. Epub ahead of print. Coggrave M, Norton C. Neurogenic bowel. Handb Clin Neurol. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev. Neurogenic bowel dysfunction: Clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence Neurourol Urodyn.
Epub Jun A systematic review of clinical studies on electrical stimulation therapy for patients with neurogenic bowel dysfunction after spinal cord injury. Medicine Baltimore.
Prevalence of upper motor neuron vs lower motor neuron lesions in complete lower thoracic and lumbar spinal cord injuries.
J Spinal Cord Med. Fecal incontinence and neurogenic bowel dysfunction in women with traumatic and nontraumatic spinal cord injury. Dis Colon Rectum. Emmanuel A. Neurogenic bowel dysfunction. Published Oct The enteric nervous system and gastrointestinal innervation: integrated local and central control.
Adv Exp Med Biol. Gater DR. Neurogenic bowel and bladder evaluation strategies in spinal cord injury: New directions. Medical and surgical management of neurogenic bowel.
Curr Opin Urol. Hou S, Rabchevsky AG. Autonomic consequences of spinal cord injury. Compr Physiol. Hultling C. Neurogenic bowel management using transanal irrigation by persons with spinal cord injury. Epub Jun 2. Kairaluoma MV. Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele. Neurogenic bowel management after spinal cord injury: a systematic review of the evidence.
Spinal Cord. Epub Mar 9. Treatments in neurogenic bowel dysfunctions: evidence reviews and clinical recommendations in adults. Eur J Phys Rehabil Med. Epub Sep Digital rectal stimulation as an intervention in persons with spinal cord injury and upper motor neuron neurogenic bowel. An evidenced-based systematic review of the literature. Ageing with neurogenic bowel dysfunction. Epub Mar Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life.
Rehabil Nurs. Powell A, Davidson L. Pediatric spinal cord injury: a review by organ system. Previnaire JG. The importance of the bulbocavernosus reflex. Spinal Cord Ser Cases. Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies.
Degener Neurol Neuromuscul Dis. Bowel dysfunction in spinal cord injury. Curr Gastroenterol Rep. Spectrum of diabetic neuropathies.
Diabetol Int. Stern M. Neurogenic bowel and bladder in the older adult. Clin Geriatr Med. Neurogenic bowel management for the adult spinal cord injury patient. World J Urol. Dietary management of neurogenic bowel in adults with spinal cord injury: an integrative review of literature. Disabil Rehabil. A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel.
Effect of quantitative assessment-based nursing intervention on the bowel function and life quality of patients with neurogenic bowel dysfunction after spinal cord injury. J Clin Nurs. Zidek K, Srinivasan R. Rehabilitation of a child with a spinal cord injury. Semin Pediatr Neurol. Reeve Foundation. The Process of Digestion Bowel management begins with the digestive process.
Neurogenic Bowel One of the main concerns for individuals with injury or disease affecting motor nerves nerves for movement is neurogenic bowel. Nerve Function in Digestion Nerve function to the bowel is complex due to the length of this huge organ.
Classification of Neurogenic Bowel In the nervous system, communication occurs by motor nerves carrying messages from the brain to the body for movement. They are the source of movement. There are three types, one for each of your muscle types: Alpha--cardiac muscle Beta--smooth muscle found in body organs Gamma--skeletal muscle Upper Motor Neurons and Lower Motor Neurons Types of Neurogenic Bowel Neurogenic bowel is classified in three ways.
How to Talk about Stool Being able to discuss stool frankly and openly with your healthcare professionals and caregivers is essential to obtaining the treatments you need.
Overall Bowel Program Guidelines: Consistency in timing is critical to success. Most people without a spinal cord injury have natural elimination habits that develop over time. The same will also happen for those living with a spinal cord injury but cues are needed to be provided as to when elimination should occur.
The bowel program accomplishes this timing. Take advantage of the gastrocolic reflex stimulation of bowel function from eating. It is strongest at the first meal of the day but can be stimulated with any meal or snack. Warm fluid can stimulate the bowel to function. Gravity assists with bowel evacuation. 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. Increase your intake of dietary fiber. Try switching your program to a different time, and be sure you schedule it after a meal to help increase intestinal peristalsis. Do your bowel program in the sitting position if you have been doing it in bed.
Try exercising before your program. Autnonomic 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. It includes the ability to focus on a task or a thought. Any type of brain injury can affect attention. Google Custom Search Terms.
View the archive of all articles. Print This Page. Skip To Main Content. What is a Bowel Program? What is the Bowel and What Does it Do? Components of a bowel program can include any combination of the following: 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. Digital Stimulation : Circular motion with the index finger in the rectum, which causes the anal sphincter to relax.
Glycerine draws water into the stool to stimulate evacuation. Mini-enema Enemeez : Softens, lubricates, and draws water into the stool to stimulate evacuation. Previous bowel history: What have your bowel habits been in the past? Timing: Do you do your bowel program in the morning or evening? At the same time every day? After a meal or warm beverage? What is the interval between programs -- half a day, one day or two days?
You should do a bowel program at least every days to reduce your risk of constipation, impaction and colon cancer. Merriam-Webster's Words of the Week - Jan. Ask the Editors 'Everyday' vs.
What Is 'Semantic Bleaching'? How 'literally' can mean "figuratively". Literally How to use a word that literally drives some pe Is Singular 'They' a Better Choice?
The awkward case of 'his or her'. New Year, Recondite Vocabulary Take the quiz. Advanced Vocabulary Quiz Tough words and tougher competition. Take the quiz. The more consistent you are with every aspect of the bowel program the more consistent your results will be. Any change, no matter how small, can have a big impact on your bowel results. Decide how you will do the program and be consistent!
Nails, both natural and artificial, should be kept clean and gloves used. Hands should be washed with each glove change. Polished nails should not be chipped or cracked. This will assist in prevention of physical issues at the anus. Many factors determine healthy bowel management. Going to the bathroom is necessary for cleansing and health maintenance.
Regular emptying of the bowels is the primary goal of a bowel program. Being consistent with your diet, fluids, activity, medications, timing, positioning, and aids will help you achieve the right consistency for your injury and bowel program. Download PDF Version. Bowel Program for Spinal Cord Injury We understand that you are at a time in your life when thinking about going to the bathroom may have been a thing of the past.
What is a bowel program? Lower Motor Neuron vs. Upper Motor Neuron Injury The first step in establishing a bowel program is understanding your spinal cord injury and how it has affected your body. Lower motor neuron LMN injuries are usually T12 and below. These injuries are flaccid in nature; the muscles are loose and involuntary bowel movements are very common because the colon has lost its muscle tone.
People with LMN injuries may not respond to usual bowel interventions such as digital stimulation or suppositories because the spinal reflex arc is diminished or absent. The goal of bowel care for a person with LMN function is to keep the stool well formed, the rectal vault clear, and to prevent embarrassing accidents.
People with this type of injury sometimes have to do a bowel program once or twice a day to keep the lower colon free of stool.
Upper motor neuron UMN injuries are injuries that are usually T12 and above. These injuries are spastic in nature; muscle spasms are common and the colon is really tight.
People with this type of injury usually need to do digital stimulation and use suppositories to help stimulate the reflex to defecate. Getting the right consistency
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