Medication Guide App

Bowel Management Program After Spinal Cord Injury

WHAT YOU SHOULD KNOW:

Having a spinal cord injury (SCI) can interrupt the nerve pathways from your brain to your gastrointestinal or "GI" system. Neurogenic bowel is when the brain and nervous system cannot control bowel "BM" functions after a SCI. Most people with a SCI can learn how to control their bowel function. Bowel programs help you eliminate (get rid of) enough BM at regular planned times, which prevents or decreases BM accidents.

AFTER YOU LEAVE:

Take your medicine as directed.

Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

What should I do while on a bowel management program?

Most people with a SCI can learn how to control their bowel function. Bowel management programs help you eliminate (get rid of) enough BM at regular planned times. This will help prevent or decreases BM accidents. A bowel management program is made up of four parts:

  • 1. Activity: Activity is very important for everyone. It helps you to have BMs regularly. After a spinal cord injury, you will need to make a point of moving often. Change positions often from lying to sitting to standing, if possible. Have your joints moved through their full range of motion several times a day. These activities help your bowels move naturally.

    • If possible, sit up to have your BMs. This will allow gravity to help pull the BM down the bowel. Use a padded toilet stool if you have to sit more than 30 minutes to help prevent pressure sores. Make sure you do not sit on a toilet or commode chair that has seams, or cracked or broken plastic. This can cause skin problems. Make sure you use safety straps where needed.

    • You may want to try having your feet placed on a footstool so you can push down better during the BM.

  • 2. Diet and liquids: Food and liquids play an important role in your bowel program. When you eat also is important. Eat about 30 minutes before you begin your bowel care program. This will stimulate you to have a BM because of the stomach's reflexes.

    • Drink enough liquids: Not drinking enough fluid can make you constipated. Drink 8 to 12 (eight ounce) glasses of liquid each day. Follow your caregiver's advice if you must limit the amount of liquid you drink for a bladder management program. Good liquids to drink are water, juices, and milk. Avoid drinking liquids with caffeine and alcohol. caffeine and alcohol may cause dehydration (not enough fluid in the body).

    • Eat a variety of healthy foods:

      • Eat different foods from all the food groups every day. Some foods do not affect BMs, such as meat, fish, cooked vegetables, and fats. Other foods may make your BMs harder or softer. If you feel constipated, eat more foods that soften BMs. Foods that soften BMs include fresh, raw (uncooked) fruits and vegetables, whole grain breads, cereals and rice, beans, coffee, and dark chocolate. If your BMs are too soft, eat more foods that harden BMs. Foods that harden BMs include applesauce, milk and dairy foods, white breads and refined cereals and cookies, white rice, and creamed soups and sauces.

      • Many vegetables and fruits cause gas. Some gas is normal, but too much can be unpleasant. You may want to try not eating a specific food to see if it is causing you to have gas. Eating slowly with your mouth closed may help to decrease gas. Talking while chewing, and gulping your food makes you swallow air. This may also cause too much gas.

  • 3. Medicines: Many medicines cause constipation. The larger the dose you take of these medicines, the more problems you may have with constipation. Medicines that may cause constipation include some high blood pressure medicines, pain killers and sedative medicine, and iron supplements. Medicine used to treat depression, stomach pain, and bladder spasms may also cause constipation. Tell your caregivers if you are having problems with constipation so they can work with you to decrease the problem.

  • 4. Routine bowel care: A bowel care program helps you completely empty your bowel at a specific time. The program should take no more than one hour at a time. It should be done every day, every two days, or every three days. You should do your bowel care program at the same time each day so your body develops a habit. Eat food or drink liquids about 30 minutes before you start to stimulate your bowel to have a BM.

How should I do bowel care if I have flaccid (limp) bowel?

With flaccid bowel, the goal is to have firm, formed BMs that you can hold between bowel care sessions. The BMs should be soft enough so that you can easily pass them manually (without help). You should perform your bowel program once or twice a day to prevent accidents. Remember to wash your hands at the beginning, after each step of the process, and at the end. Start by emptying your bladder.

  • Step 1: Move into position. Sit up on the commode or commode chair, or in your wheelchair ready to move to the commode. Sitting up lets gravity help you have a BM. You may also lie on your side.

  • Step 2: Do manual extraction. Put on gloves and lubricate one or two fingers very well. Gently insert the fingers into your rectum and scoop out the stool.

  • Step 3: Stimulate your bowel. Perform digital stimulation to help your anal sphincter completely relax. Put a well-lubricated, gloved finger into your rectum about 2 to 3 inches inside your anus. The goal is to massage the inner sphincter (a ring of muscle inside the anus). To do this, point your finger toward your belly button and move it in a circle around the walls of the rectum. Keep moving your finger in a circle staying in contact with the rectal wall for about 20 seconds. Do not continue for longer than one minute.

  • Step 4: Do the Valsalva maneuver. This procedure is good if you have control over your abdominal muscles by helping to push out the BM. Take a deep breath and bear down but do not let your air out. Try to tighten your stomach muscles at the same time. Doing valsalva maneuvers increases the pressure around the bowel which pushes stool out. Do it for 30 seconds at a time until you have finished having the BM.

  • Step 5: Move around. Lift yourself and bend forward and sideways if your upper body is strong enough. Doing this with valsalva maneuvers helps change the position of the bowel. This helps push out the BM.

  • Step 6: Wait to have a BM. Wait about 10-15 minutes for the BM to start. If you have not had a BM within 15 minutes, insert a suppository.

  • Step 7: Completely empty your bowel. Perform digital stimulation two more times after the BM, waiting five to 10 minutes in between. This makes sure your bowel is as empty as possible.

How should I do bowel care if I have spastic bowel?

With spastic bowel, your bowel functions normally to form soft BMs and your sphincter remains tight. Remember to wash your hands at the beginning, after each step of the process, and at the end. Start by emptying your bladder.

  • Step 1: Insert the suppository. Some suppositories lubricate (moisten) the rectum to help the stool come out easier. Other types soften the stool and also stimulate the bowel to have a BM. Caregivers will help you decide if you need a suppository, and which kind to use. Insert a suppository lubricated with a clear jelly-like lotion after removing any stool that is in the way. Put in the suppository. Using the finger of one gloved hand, or a suppository inserter, place it as high into the rectum as possible. The suppository should rest against the side of the rectum, not in the middle of stool. Slowly take your finger or the suppository inserter out, making sure that the suppository does not come out.

  • Step 2: Move into position. Sit up on the commode or commode chair, or in your wheelchair ready to move to the commode. Sitting up lets gravity help you have a BM.

  • Step 3: Massage your abdomen. Massage (gently rub) your abdomen (belly) for 5 to 10 minutes. Place the palm of your hand on the lower right part of your abdomen. Press in and move up to your ribs, straight across to the left side of your abdomen. Then keep pressing in as you move your hand down the left side of your abdomen. Massaging in this method, massages the length of the colon toward your rectum. Repeat this 10 times, waiting about 30 seconds in between.

  • Step 4: Wait for the suppository to work. Wait about 10 to 15 minutes for the BM to start.

  • Step 5: Stimulate your bowel. If you have not had a BM in 15 minutes, perform digital (finger) stimulation. Put a well-lubricated, gloved finger into your rectum about 2 to 3 inches inside your anus. The goal is to massage the inner sphincter (a ring of muscle inside the anus). To do this, point your finger toward your belly button and move it in a circle around the walls of the rectum. Keep moving your finger in a circle staying in contact with the rectal wall for about 20 seconds. Do not continue for longer than one minute. Repeat this every 5 to 10 minutes until you have a BM.

  • Step 6: Completely empty your bowel. Perform digital stimulation two more times after the BM, waiting 5 to 10 minutes in between. This makes sure your bowel is as empty as possible.

Why should I keep a bowel care record?

Keeping a bowel care record helps you and your caregivers know whether your bowel program is working. Write down the following information after each bowel care session:

  • Date: Write down the date.

  • Start time and end time: Writing down what time you started and finished, helps you and your caregivers know how well things are going. Caregivers can help you learn ways to speed up the process. They also can show you where to slow down if needed to give your bowel time to do its work.

  • Position: Write down the position (sitting or lying) that you were in while doing bowel care.

  • Stimulation: Write down any methods used while doing bowel care, such as using a suppository, or digital stimulation.

  • Assistive actions: Write down other methods used to empty your bowel. This may include abdominal massage, or the valsalva maneuver. Note how many times you used each method.

  • Time of the BM: This information helps caregivers know how successful your bowel care program is.

  • Describe your BM: This can help caregivers know if there are any problems with your bowels, like constipation or bleeding. Caregivers may be able to discover bowel problems by how your BM looks.

  • Comments: Write down any other things you notice or if you have problems, like cramps, muscle spasms, or accidents. Note whether there are any skin problems from your bowel care equipment.

CONTACT A CAREGIVER IF:

You have:
  • Abdominal (belly) pain or a distended (swollen) abdomen that is worse than normal and is not better after performing bowel care.

  • Bleeding from the rectum.

  • You have a fever.

  • Vomiting or diarrhea for two or more days.

  • You have chest pain or trouble breathing that is getting worse over time.

SEEK CARE IMMEDIATELY IF:

  • You suddenly feel lightheaded and have trouble breathing.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

  • You have the symptoms of autonomic dysreflexia that are not relieved by your bowel program or emptying your bladder, such as:

    • A sudden increase in blood pressure.

    • Blurred vision or seeing spots.

    • Cold, dry, skin with goose bumps below your SCI.

    • Hot, sweating, flushed (red) skin above your SCI.

    • Sudden throbbing headache.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Bowel Management Program After Spinal Cord Injury (Discharge Care)

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