Caregiver’s Corner: Bowel Care Program for Persons with Quadriplegia
A bowel care program is an essential aspect of overall health and wellness for for persons with quadriplegia. Our gut health directly impacts vital systemic functions like our immune system, mental health, and independence. More than half of people with spinal cord injury (“SCI”) report having symptoms of bowel dysfunction.
SCI interrupts how the gastrointestinal tract sends signals to the brain and bowel, and that connection no longer works the same way it did pre-injury. Gastrointestinal disorders are one of the most common complications for quadriplegics, with 95% of SCI patients requiring some form of therapeutic intervention to initiate a bowel movement.
If a spinal cord injury is located at T12 or higher, an individual may lose the ability to feel when the rectum is full. The bowel empties by reflex (called “reflex bowel”). With this type of injury, when the rectum is full, defecation will occur on a reflex basis.
A bowel care program helps allow defecation to occur at socially appropriate times and places, rebuilding confidence and often enabling individuals to return to activities and social events they previously enjoyed.
What is an Effective Bowel Care Management Program?
Just like every person is different, every injury is different, and patience is often required to determine the bowel care management program that works best for you.
It’s important to remain hopeful, however, because there are many options and steps you can take for managing your bowel care.
Follow a Regular Bowel Routine:
Bowel movements ideally occur every day, or every other day.
Following a regular routine minimizes accidents, and actually ‘teaches’ the bowel when to ‘go’. Many people living with paralysis will select a time of day that fits best with their lifestyle and schedule. Some things to consider that can trigger bowel movements include:
● Waking up in the morning, typically within about 30 minutes
● 30 minutes or so after a meal
● Physical movement
● Stretching and range of motion exercises
How Long Should a Bowel Management Program Take?
Nobody wants to plan their day around their bowel, and a bowel management program doesn’t need to take hours.
Bowel programs generally require 30-60 minutes to complete. Taking into consideration what products you use in your bowel management program is important. Time consuming bowel management reduces quality of life, independence, and comfort.
Enemas and Bowel Management Programs
Enemas generally produce bowel movements more quickly than oral laxative products. Enemeez® mini-enemas typically produce a bowel movement in 2-15 minutes. In some cases, digital stimulation can also be used every 10 minutes. Some people with a lower motor neuron (LMN) or flaccid bowel may begin their bowel management program with digital stimulation as well.
Lifestyle and Bowel Management Programs
A lifestyle centered around health, wellness, and self-care is essential to an effective bowel management program.
To bolster wellness and a healthy gastrointestinal tract it’s important to consider the following in your daily life:
Hydration: Proper hydration is not only good for your body, it is great for your bowels, too. Drinking water is essential to both your bowel and bladder management program, as it helps keep waste moving through the gastrointestinal tract, reduces the risk of constipation, and makes it easier to empty both your bowel and bladder.
Fiber-Rich Foods: Incorporating fiber into your diet is one of the most important things you can do to manage your bowel care. Foods that are high in fiber include legumes, chickpeas, raspberries, broccoli, kidney beans, split peas, pears, avocado, and even dark chocolate!
Things to Avoid or Moderate: Caffeine, sugar, unhealthy fats, and sodium take a toll on your overall health and do not promote healthy stool. Be mindful of your overall diet and keep unhealthy foods and beverages to a minimum, or even better eliminate them altogether!
An effective bowel care program for individuals living with paralysis can help minimize bowel care and maximize lives.
Disclaimer: The material contained is for reference purposes only. This is not medical advice and you should talk with your doctor about your unique healthcare needs.
Stines, Bierner-Bergman, & Goetz, 1997
Higgins, Johanson, 2004
Federal Register / Vol. 50, No. 10 / Tuesday, January 15, 1985 / Proposed Rules; pgs 2124–2158.