Posted by Nurse Linda in Life After Paralysis on August 27, 2021 # Health

woman in wheelchair exiting her vanGas, or using the medical term, fluctuance, is an essential part of bowel metabolism. It is a natural part of the digestive process that assists in propelling digesting food through the bowel. In children, neurogenic bowel can be confused with or in addition to colic.

The bowel works by propelling digesting food through it in several ways. First, digesting food from the stomach enters the bowel as a substance called chyme. This is a thick, watery, broken-down form of food and water. Chyme needs to contain enough fluid to keep digesting food moist throughout the entire length of the bowel. If chyme dries out before it reaches evacuation, the hard or constipated stool is difficult to pass, rough on the intestinal wall leading to injury, and can completely stop moving leading to impaction.

The bowel wall is muscular, which pushes the chyme through, keeping it moving in one direction. This muscular propulsion is called peristalsis. As the chyme is passing along, nutrients and fluid are constantly being removed throughout the entire bowel length to be used by the body's cells. An injury to the central nervous system can slow the messages to and from the brain, causing peristalsis to decrease. This slowing of the muscular contractions of the bowel allows chyme to stay in the bowel longer, even though the fluid is still being taken from it at the same pace.

Chyme eventually is processed into a waste product which is stool. In the small intestine, the digesting food or chyme is very watery as it is mixed with fluid from drinking. The large intestine particularly creates the formation of stool. Chyme thickens throughout the bowel, but the stool formation which you see expelled from the body, is not fully completed until closer to the end of the large intestine, prior to evacuation.

There are processes that assist peristalsis with propelling chyme throughout the bowel. A byproduct of the removal of nutrients from chyme results in the production of gas. Gas travels the same path as chyme. As gas builds in the bowel, it is eventually excreted with stool or just excreted out of the body through the rectal opening.

Colic is a term known to most parents. It is a time of prolonged fussiness and discomfort exhibited by a child, usually beginning between the ages of six weeks and resolving at three to four months of age. The reason for colic is unknown, but it has been considered to be a possible culprit in digestive or bowel dysfunction. Colic has sometimes been noted to resolve if the infant passes gas. However, this gas release is most likely from swallowed air due to the crying spells. Occasionally, parents have reported that flexing the hips and knees toward the lower torso helps expel gas from the uncomfortable infant. The reality is that no one knows the source of colic, but some parents feel it is a result of abdominal distention, slow-moving bowel or overproduction of gas. There may be a connection, or it may be a coincidence.

A diagnosis of neurogenic bowel, on the other hand, can produce an excessive or too little amount of gas. Neurogenic bowel slows the process of passing chyme as well as moving the resulting gas. On the other hand, gas can be released with chyme left behind. The diagnosis of neurogenic bowel means that the messages sent by the nerves to and from the brain can be interrupted or miscommunicated. This interrupts the muscular function of the bowel. Making is slower in response to the presence of chyme and gas.

If you wonder about the speed of function of your child's bowel, a measure of transit time can be performed. There is a testing of this process that your healthcare professional can conduct in a radiology department. In this case, the child is given an oral feeding that can be seen as it passes through the digestive tract. A series of x-rays is completed over time to see where the specialized feeding passes through the bowel. The x-ray series must be done over several hours or even a day or more. You can come and go at the prescribed radiology times. A significant amount of information is gathered, including how long it takes for food to pass from entering the mouth until exiting the body. Other information gathered includes any strictures, fistulas, or alterations in the child's bowel. Gas buildup can be seen.

If your child's healthcare professional determines a transit study should be completed, by all means, have it done. If you are curious and your child is older (over three years) and has been eating solid foods, try giving them some corn or beans with the skin on. Watch their stool and see when the undigested particles of that meal are expelled. That is your child's transit time, from the time taking food in until it is expelled or expelled in the bowel program. This is not for infants or young children. In children without neurogenic bowel, toddler transit time is about 31 hours but can be up to 74 hours, school-aged children transit time is about 36 hours or up to 79 hours and teen transit time is 43 hours or up to two to three days, much like adults. The study of ages and transit time in pediatrics is found here. Children with neurogenic bowel will have longer transit times. As your healthcare professional indicates, the stool is always in the bowel, so bowel care should be provided. This is just to see how quickly your child's bowel functions.

The bowel is very elastic. It will expand in diameter if chyme or, eventually stool is present. This bit of expansion of the bowel wall sends the signal to the brain to contract the bowel muscle to propel the waste to move along and eventually out of the body. However, a neurogenic bowel is not able to send or receive messages effectively. Therefore, the chyme or stool might not move as efficiently. The buildup of chyme and stool will expand the bowel wall, overstretching it. As time passes, this overstretched bowel wall cannot contract back to its regular shape, making the muscle function less effective.

Often, people think that stool overflow is a bowel movement. Sometimes, a bit of stool is eliminated because of gas or just because the bowel is full in the neurogenic bowel. The rectal opening can be a sphincter that is relaxed, so stool flows out at the point of least resistance. But the rectal sphincter can be unusually tight due to tone (spasticity). In this case, the stool backs up in the bowel or stacks up in the bowel because it cannot be released. Both non-removal of stool and tone (spasticity) can lead to an overstretched bowel.

The treatment for a neurogenic bowel is a bowel program to help propel the resulting stool out of the bowel. This will also help remove gas as a part of the elimination process. In addition, a bowel program will help to keep the bowel functioning utilizing the natural process. A bowel program for children is performed by inserting a bowel stimulant into the rectum shortly after a meal. For infants and toddlers, a glycerin suppository is either cut into fourths-the long way of the suppository, a half or a whole. Older children and teens may rely on a stronger stimulant suppository or mini enema. For a smaller child, you will use your well-lubricated little finger for insertion. Digital stimulation will be used as appropriate for the child. Your healthcare professional will direct you in how often this should be done, which stimulant to use, if other aids and medication should be used and how to perform this procedure.

As your child develops, you will turn bowel care responsibility over to them to ensure their independence as an individual. Start even with an infant, talking about what you are doing. As the child becomes more developmentally aware, have them help gather supplies, eventually inserting the suppository and later performing the digital stimulation. Typically, by school age, you will want your child to be independent in this toileting activity. Remember, this is your child's normal, so encourage their independence.

If your child has gas that causes discomfort, triggers tone (spasms) or leads to episodes of autonomic dysreflexia, try some of the colic/gas relief measures. Movement of the legs will help stimulate the abdominal muscles, which will assist in moving gas along. Therapy of the lower extremities such as range of motion exercises, use of assistive devices and therapeutic equipment for leg movement, aquatic and even standing in a standing frame will help gas move through the bowel. Rolling in bed from side to side or playing rolling games on the floor assist with gas movement as well as stool movement.

Often, people want to provide gas relief with medications. Be cautious in doing so. The gas serves a purpose in the gut to move and propel chyme and stool for expulsion. Reducing or eliminating gas with medication precludes this natural process from happening, slowing the chyme even more. In addition, gas-eliminating medication will allow more time for water extraction, creating a constipated stool and difficult to pass. Instead, review your child's diet. Note if your child consumes a lot of gas-producing foods. You might be able to modify the diet to help resolve some of the excessive gas issues, but do not eliminate gas-producing foods entirely. Gas is needed for the bowel to work effectively.

People accept the fact that children wear diapers. However, no matter your child's age, a diagnosis of neurogenic bowel requires a bowel program. The bowel program will keep your child's bowel healthy throughout their adulthood. 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.