Avoiding Bowel Complications-Part 2

Posted by Nurse Linda in Life After Paralysis on July 06, 2020 # Health

Last week started a review of the bowel program process with presentation of the usual routine. This week, a closer look at some of the complications that can hamper the bowel program is reviewed.bowel diagram

Autonomic Dysreflexia

Problems with your bowels or bowel program may lead to episodes of Autonomic Dysreflexia (AD). The number one source of AD is usually something amiss with the bladder, but the number two source is the bowel (no pun intended). AD can develop from an overfilled bowel, diarrhea, gas, impaction or even due to the stimulation of the bowel program itself.

The most common signs of AD are a pounding headache and elevated blood pressure from your individual normal. There are other signs as well. Sometimes silent AD can be occurring which is an elevated blood pressure with no other symptoms. Be well aware of all of the signs of AD by checking the wallet card. AD is a serious medical emergency that requires attention. If you have multiple episodes of AD with your bowel program, medication can be prescribed to control it.

Changing your bowel program

Consistency in timing is the rule for training your bowel to work effectively. However, sometimes life changes and you need a new schedule. This cannot occur very often as you really need steady timing for your bowel program to work. However, on that rare occasion, you can change your bowel schedule.

Start your bowel program at your newly selected time. Stop, your usual program. Perform the bowel program at the new time daily until stool is evacuated at the new time for 2-3 days with no incontinence in between. You may not have results daily. Then you can move to every other day at the new time. It can take weeks or sometimes even months to regulate your bowel to the new schedule. Accidents in between can be frustrating so be prepared for that consequence. Some individuals will sail through the process but by far the majority will find changing bowel program times to be a challenge at best.


Gravity is often overlooked as one of the biggest helpers in bowel movements. You might have been taught just to do the bowel program in bed. However, sitting upright will help stool pass from your body.

To accommodate sitting, you are eligible for a commode chair or even a shower chair which can be dually used for your bowel program. Have your therapist, nurse or healthcare professional assist you with ordering your commode to ensure you have all the adaptions needed specifically for you such as appropriate breaks, removeable and elevating foot rests, removeable arm rests, head rest, reclining, appropriate padding for skin care and safety belts. Be sure the size of the commode can be accommodated in your home. Check with your insurance case manager to learn about the payment system.

If you have a medical reason that you cannot sit up for the bowel program, position yourself on your left side. The bowel program will work better in bed if you are on your left side due to the anatomical placement of the bowel within the body.


One of the factors for everyone that helps the bowel move is use of your muscles, especially the abdominal muscles. Movement helps everyone’s bowels to work more efficiently and functionally. People who live sedentary lifestyles even without spinal cord injury have more difficulty with bowel movement than those who move their bodies.

There are some simple activities that will insert movement into your life. Roll from side to side when in bed, do wheelchair pushups for pressure release, do range of motion exercises especially to the legs and hips, exercise especially the lower body or have someone do these activities to your body. Since the bowels are inside the body, we don’t see them moving but muscle action helps propel stool through the bowel. Therefore, supply what is needed to enhance the process.


Bloating and gas can be an issue for individuals with neurogenic bowel. The slowing of the bowel can lead to a buildup of gas in the bowel which appears as bloating. Movement can help resolve some of the issue because it pushes gas along in the bowel. Eating foods that produces little gas can help.

Gas reducing tablet medication is also available. Take gas reduction medication when needed, not as a routine, if possible. Be cautious with your reduction of gas reduction technique. Gas in the bowel is one of the ways chyme is propelled through the bowel. It is a necessary action. Eliminating gas can block the bowel function process.

Sensation with a bowel program

Individuals with incomplete injuries or with partial preservation of some nerves may have some sensation with the bowel program. The messages may be transmitted that something is going on in the bowel or the messages can be mis-transmitted as pain. The simplest treatment is to use a rectal topical anesthetic at the time of the bowel program. This analgesia can be inserted prior to the initiation of the bowel program or it can be used as lubricant, depending on your specific needs. If there is no success with this treatment, neuropathic pain medication or spasticity medication may be necessary.

Bowels can be injured

Bowels can be affected by normal action. Too infrequent bowel programs, gas, impaction, aggressive digital stimulation or manual removal of stool can lead to injury to the delicate bowel tissue. Fissures, hemorrhoids, fistulas, diverticula and overstretching of the bowel can occur. Be gentle when doing a bowel program as well as use generous amounts of water-soluble lubricant.

Overtime, too much overstretching of the bowel can lead to something called mega-colon. The bowel expands and contracts as chyme and stool passes through it. Continual over stretching from lack of a bowel program, excessive gas or just slow-moving stool can be the source of the over stretch. Once mega-colon has occurred, the bowel will not contract back to its typical size. It becomes flaccid, unable to move stool along rendering it ineffective. This is important for everyone but especially those who have lower motor neuron injury (LMN) where the stool stores until it is manually removed.


Some individuals think that a colostomy would be a better alternative because they don’t like the idea of performing the bowel program or it takes too much time or any of a variety of reasons. The goal of the bowel program is to have your bowel function in its normal way. This maintains the body in the best condition. A colostomy is an artificial opening in the abdominal wall for stool to be emptied from the bowel into a collection bag.

As enticing as this sounds, it can be more difficult to maintain a colostomy than to perform a bowel program. As with any surgery, it can be dangerous for an individual with spinal cord injury especially due to respiratory complications. Be sure to evaluate the risks vs. benefits before thinking about any dramatic procedure.

Colostomy bags are difficult to secure to the abdomen. The brochure makes bag use look easy, but I have yet to see any patient with or without SCI with the six-pack abdominals depicted in the brochures that are needed to secure the bags. Securing a colostomy bag on a typical abdomen can be a challenge.

Some individuals will require a colostomy for medical reasons. When required for your health, it is not the end of the world, but it is not a quick fix. It is a better option to maintain your bowel’s normal function if you can. Natural function is always a better option than a manmade function.


Your bowel program may be well functioning for years without any issues when suddenly one day, it is not working so well. Part of the issue can be long term spinal cord injury, but more than likely aging is the issue. As we age, the bowel can get a bit lazy. Combined with the bowel challenges of SCI this can be a compounding complication. Attempt all the activities above to improve your bowel function. You may need to add bulk or move more. It is a trial and error process to get the aging bowel going again but it does happen.

Sometimes, individuals get fixated on treatments, adding things and incorporating different ideas. Starting from the beginning might help in creating an improvement. Talk with your healthcare professional to review your techniques and medications. Sometimes people get caught in a cycle of adding things to make the bowels move and adding other things to stop it. Let the bowel do its natural processing with minimal intervention if possible. Nurse Linda

Pediatric Consideration:

The bowel is a very redundant organ of the bowel. It has one function. Remove nutrients and fluids and move chyme along for removal. Of all the organs in the body, the bowel is one that works simply compared to others. Making the bowel program normal for your child starts with your adult acceptance. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.