Neurogenic Bowel After Spinal Cord Injury

WHAT YOU SHOULD KNOW:

Neurogenic Bowel After Spinal Cord Injury (Discharge Care) Care Guide

A spinal cord injury (SCI) may interrupt nerve pathways from your brain to your gastrointestinal or “GI” system. Neurogenic (noor-oh-JEN-ik) bowel is a condition that happens when the brain and nervous system cannot control bowel functions after a SCI. You may not be able to feel that your bowels are full. You may also not know when your bowels will empty. You may have a condition called spastic bowel, or flaccid (limp) bowel. Many people learn how to control bowel functions after a spinal cord injury. Bowel management training, and changes to your diet may help you regain control over bowel function.

AFTER YOU LEAVE:

Take your medicine as directed.

Call your primary 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 know about neurogenic bowel?

There are two common types of neurogenic bowel:

  • Spastic bowel: This kind of neurogenic bowel is also called reflexic bowel, or upper motor-neuron bowel. Messages between the brain and the colon are interrupted (stopped) when a SCI is at the neck (cervical) or chest (thoracic) level. The spinal cord can still guide bowel reflexes with spastic bowel. Even though you do not feel the need to have a BM, your body's reflexes can do it automatically. When the bowel becomes full, a BM occurs but in between BMs your anal sphincter stays tight.

  • Flaccid (limp) bowel: This kind of neurogenic bowel is also called areflexic bowel, or lower motor-neuron bowel. Flaccid bowel happens when the injury is at the lumbar (lower back) or sacral (tail bone) area of the spinal cord. The nerves that go out from this area to the bowel also may have been damaged. This kind of injury decreases the peristalsis and the reflex (automatic) control of your anal sphincter. You cannot feel that you need to have a BM and your anal sphincter may not be able to hold BM in. The sphincter does not close tightly enough, so BM leaks out.

Can anything be done about neurogenic bowel?

Bowel programs can help you learn how to control bowel function. These programs help you get rid of enough BM at regular planned times, which prevents or decreases BM accidents. Ask caregivers for more information about bowel management programs.

What other problems might happen with my GI tract?

  • Autonomic dysreflexia:

    • Autonomic dysreflexia is a condition that happens when your body reacts to a problem. Common problems causing autonomic dysreflexia include having a full bladder, or being unable to have a bowel movement. It is also called "AD" or autonomic hyperreflexia. This very serious emergency can be life threatening. AD causes your blood pressure to go dangerously high. High blood pressure can cause a stroke, seizure, and even death. It is most common in people who have a SCI at or above the 6th thoracic level (T6).

    • Noxious stimuli are things that the body considers bad or hurtful. AD is most often caused by noxious stimuli, such as bowel or bladder problems. An over full bladder, being constipated, or having a bowel obstruction are the most common causes of AD. Other things also can cause AD, such as a bladder infection or blood clot in your leg or in your lungs. A pressure sore, a wrinkle in clothing, or an erection also can cause AD. Ask your caregiver for more information about autonomic dysreflexia.

  • Constipation: Constipation is a condition where you have fewer bowel movements (BMs) than usual. You may also have hard, dry BMs, that are hard to pass. Constipation may cause headaches, stomach pain, and make you feel sick to your stomach. Caregivers will work with you to find out what is causing your constipation. Causes include some foods and drinks, lack of exercise, and some medicines. Ask caregivers for more information about preventing constipation.

  • Diarrhea, or too much gas: Diarrhea is another word for loose stools (BMs). Some people find that after they eat spicy, fatty, or greasy foods they get diarrhea. Other people find that caffeine from coffee, tea, chocolate, and soft drinks gives them diarrhea. Keep a record of what and when you eat. This can help you learn what foods cause you to have diarrhea or too much gas. Then you can avoid these foods.

  • Hemorrhoids: Hemorrhoids are veins in your rectum and anus (rear-end) that become enlarged (swollen). This can be caused by hard, constipated BMs, and straining or pressure when having BMs. To prevent hemorrhoids, drink enough fluids and stay active. Sitting on a gel or air cushion can keep your hemorrhoids from getting larger and also can help prevent bed sores. Tell caregivers about your hemorrhoids. They may order medicines or suggest other ways to treat them.

  • Rectal bleeding: Blood in your BMs can be caused by several things. Doing digital stimulation too roughly can injure your rectum and cause bleeding. Make sure you perform digital stimulation gently and use enough lubricating jelly. Make sure your fingernails are short. Hemorrhoids may bleed when BMs move past them. Use more lubricating jelly if your hemorrhoids are swollen. Avoid straining when having BMs. Using stool softener medicine, drinking enough water, and eating a high-fiber diet can help prevent rectal bleeding.

Where can I go for support?

  • Having a spinal cord injury is life changing for you and your family. Accepting that you have a spinal cord injury is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with a spinal cord injury.

  • You may want to join a support group. This is a group of people who also have spinal cord injuries. Ask your caregiver for the names and numbers of support groups in your town. You can contact one of the following national organizations for more information:
  • American Spinal Cord Association
    2020 Peachtree Road, NW
    Atlanta, Georgia , 30309-1402
    Phone: 1- 404 - 355-9772
    Web Address: www.asia-spinalinjury.org
  • National Spinal Cord Injury Association
    1 Church Street, Suite 600
    Rockville , MD 20850
    Phone: 1- 800 - 962-9629
    Web Address: www.spinalcord.org

Wellness hints:

  • Eat a variety of healthy foods. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. Ask your caregiver if you need to be on a special diet.

  • Drink six to eight (8 ounce) cups of liquid each day. Follow your caregiver's advice if you must change the amount of liquid you drink. Good liquids to drink are water, juices, and milk. Limit the amount of caffeine you drink. Caffeine may be found in coffee, tea, soda and sports drinks and foods.

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.

  • You start bleeding from the rectum.

  • You have a fever.

  • You start vomiting or have 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 bladder emptying. These may include:
  • 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.

© 2013 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 Neurogenic Bowel After Spinal Cord Injury (Discharge Care)

Hide
(web3)