Spinal Cord Injury (SCI): Managing Your Bowel

After an SCI, your bowel may not work the same way as before. To help you adjust to and manage the changes, your health care team has helped you create a bowel program to follow on a regular basis. It's up to you to put this program into practice. Doing so will help you remain active, social, and healthy.

SCI can damage the nerves involved with bowel function. As a result, you may not be able to tell when you need to have a bowel movement. How your bowel is affected depends on the level and severity of your injury:

• An upper level SCI (T12 or higher) may cause a reflexic bowel. With this type of problem, a reflex is triggered when your bowel is full. This causes your bowel to empty. The message that this is happening never reaches your brain so this leads to accidents.
• A lower level SCI (below T12) may cause a flaccid bowel. With this type of problem, the muscle around the anus remains open, but the bowel has trouble emptying on its own. Stool needs to be manually removed to prevent leakage and the bowel becoming blocked with too much stool.

Your bowel program gives you greater control of your bowel function. This helps you have regular bowel movements with fewer accidents. It also helps reduce your risk of complications. To ensure the success of your bowel program:

• Do your bowel routine as instructed. You'll have a bowel routine to complete each day to remove stool from your bowel. The frequency of this routine may change as you find out what works best for you. Most bowel routines take about 45 to 60 minutes. Your health care team will work with you to make sure you can do all of the steps to your bowel routine safely and well.
• Stick to your bowel care schedule. Doing your bowel routine on a schedule helps retrain your bowel to have regular bowel movements. This reduces your risk of accidents. You may also find it helpful to keep a bowel care record to track how well your bowel routine is working.
• Follow the diet instructions you're given. What you eat and drink affects how well your bowel works. You may need to increase the amount of fiber in your diet. Fiber adds bulk to stool and makes stool softer and easier to pass. You may also need to not have certain foods that cause gas or make your stool too soft (diarrhea) or hard (constipation). You may also need to drink plenty of fluids each day. Water is the best choice.
• Exercise regularly. Being active helps keep stool moving through the bowel. This makes constipation and blockage less likely. You may be taught range-of-motion exercises and position changes that make bowel movements easier to pass.
• Take medicines as directed. You may have been prescribed medicines to help stimulate a bowel movement during your bowel routine. You may also be prescribed stool softeners. Don't use laxatives without talking with your doctor first. These can make bowel problems worse over time. Opiates (narcotics) will slow your bowel and make the constipation worse.
• See your doctor and health care team for regular visits. These help monitor your health. If you need to change part of your bowel care program, let your doctor know right away. Together, you can make adjustments that work for you.

Contact your doctor right away if you have any of the following signs of a bowel issue:

• Fever of 100.4°F (38°C) or higher, or as advised by your doctor
• Hard, loose, or watery stools
• Black, tarry stools
• Bleeding from the rectum
• Stomach pain
• Swollen or hard stomach
• Nausea or vomiting
• Weight loss
• Loss of appetite
• Pounding headache (may be a symptom of AD)

Note: Autonomic dysreflexia (AD) is a problem that can happen in some people with SCI. It causes a sudden spike in blood pressure that can be dangerous if not treated. Bowel problems can sometimes trigger AD. Your doctor will let you know if you're at risk for AD and what to do if it happens.

Don't let your injury or bowel problem keep you from living an active and full life. Your body may have gone through some changes, but you're still the same person. And you can still do many of the things you've always enjoyed. This includes working, playing sports, hanging out with friends, and dating. If you need more support, let your health care team know. They can refer you to counseling, if needed. Also, reach out to family and friends and let them know how you're feeling. You may find it helpful to join a support group as well. This allows you to talk with other people who are going through similar experiences as you.