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Neurogenic Bowel After Spinal Cord Injury

What is neurogenic bowel?

A spinal cord injury (SCI) may interrupt nerve pathways from your brain to your gastrointestinal or “GI” system. Neurogenic bowel is a condition that happens when the brain and nervous system cannot control bowel functions after a SCI.

How does the GI system move food and drink through the body?

  • The GI system starts at the mouth, which is connected to the stomach by a tube called the esophagus. The small intestine leaves the stomach and continues to the large intestine or colon. Together the large and small intestines are called the bowel. The last part of the bowel is the rectum that ends in the anus. The anus is kept closed by the anal sphincter, which is a muscle band that works like a drawstring on a purse.

  • Food leaves the stomach and moves through the bowel with a wave-like movement called peristalsis. Fluid is taken out of the digested food while it is in the colon. The colon stores the remaining waste materials that are called bowel movements (BM), stool, or feces until it is time to have a BM. When the BM moves from the colon into the rectum, a reflex (automatic) action causes the anal sphincter to close. Normally, people can feel the BM in the rectum, and they can tighten their anal sphincter. This is a voluntary action and works with the reflex action to keep the BM from leaking out until the person is ready. When they get to the toilet, they can relax the sphincter and have a BM.

What happens with my BMs after a spinal cord injury?

After a SCI, you may not have voluntary control of having a BM. The automatic muscles of the GI system will continue to empty your bowels. At first, you may not be able to feel that your bowels are full. You also may not know when the automatic muscles will empty your bowels. 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 stopped when a SCI is at the neck or 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?

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. This may help prevent or decrease BM accidents. Ask caregivers for more information about bowel management programs.

What other problems might happen after a spinal cord injury?

  • 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

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about neurogenic bowel. You can then discuss choices with your caregivers. Work with them to decide what choices may be best for you. You always have the right to refuse and make your own decisions.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.

© 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.

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