Increasing Bowel Transit Time

Posted by Nurse Linda in Life After Paralysis on March 18, 2021 # Health

If you are doing well with your bowel program and are satisfied with it, keep doing what you are doing. Some individuals are looking for help as they are dissatisfied with their process. Others will find they are doing well but will be looking to keep their bowel program functioning for a lifetime due to uncontrollable factors.bowel graphic

The biggest issue that I hear is about the time it takes to complete the bowel program. Difficulties in the length of time are seen more often in individuals with reflexive bowel or those in the cervical or thoracic spinal levels. Those with a flaccid bowel will find this information helpful in planning how to maintain long-term bowel care.

The bowel program for individuals with higher-level injuries takes an average of about one-half hour from start to finish. I know many readers will be wondering who does the bowel program in such a short amount of time, but it does happen. Those with lower-level injuries will manually evacuate their bowel, which can take less time but needs to occur with more frequency.

The time it takes for food to enter your body and leave as stool is called transit time. There are sophisticated tests that can assess the timing of your bowel to work from intake to output. These tests are typically performed in interventional radiology clinics. They involve radiopaque markers administered by IV, ingested by mouth or instilled in the rectum. There is also a test where the individual swallows a pill that contains a tiny camera that will photograph the journey throughout the digestive system. If you are recommended to have one of these tests, it is a good idea to follow through as there will be information gathered that will help you understand the working of your gastrointestinal system as well as to find issues that may be affecting the timing of passage of stool such as an obstruction or other internal issue.

On the other hand, if you are wondering about your transit time, you can test yourself at home. You will not get all of the helpful information that formal testing will provide, but you can know the average amount of time it takes for your body to move food through your gastrointestinal system from mouth to rectum. The simple answer is to eat corn. Corn is difficult to digest but great roughage. You get the nutrients from it but as you already know, some chewed kernels will come out in your stool.

Have a meal where you eat corn. Note the day and time when you eat the corn. An average serving will do. You do not need to overdo eating corn. Then no eating corn until you see it in your stool. Note the day and time you see the corn in your stool. That is your transit time, from when the corn is eaten to when it is expelled. Everyone has a different transit time, and it can change depending on what you are doing, the amount and kind of fluid you drink, what you eat, how much you exercise, and how you feel.

The average transit time for individuals without neurological issues is 12 to 18 hours. This time is from a result of medical testing. In a natural setting, the stool will remain in the rectal vault until eliminated. Transit time does not mean that you must have a bowel movement. It approximates the time of passage through the gut. Individuals with spinal cord injury resulting in neurogenic bowel, both reflexive and flaccid, will have a longer transit time as the passage of food through the bowel can be slower. This is because messages to the brain to increase the muscle contractions in the bowel are not being transmitted or transmitted fully.

You can speed up your bowel transit time by making some lifestyle changes. At the risk of repeating myself, one of the best ways to increase your bowel's function is to add activity into your life. Any form of exercise will reflect in the muscles of your abdomen. Become involved in exercise through movement to your ability. The activity can be provided through your own body if you are able to do so or passively by someone moving your body for you.

Surprisingly, standing, even though it is static, is an effective way to add activity to your body. Standing stretches your muscles in a different direction from sitting and adds weight through your bones. This can help your bowels to function. Standing frames need to be authorized by your payor. Your healthcare professional can request one if your health situation allows it. The benefits to standing are many, so it is a great start.

Movement can be added by doing a range of motion exercises or having someone do them for you. Light exercise can be more beneficial to your bowel than heavy exertion. The light movement will increase blood flow to the bowel, which aids in movement. Spinal cord injury results in an issue with the nerves, but increased blood flow also serves as a milder stimulator.

When you have your body moved, your nerves and muscles are responding to the activity. This provides input to the body that is otherwise not being received. You might not recognize that something is happening, but your body will. Eventually, you might notice that you just feel better in general.

Movement of the body and mental wellbeing are closely connected. An example is a 'runner’s high’ where people who do a lot of exercise or movement to their bodies feel exhilarated. This is due to endorphins being released into the body from movement. An individual most likely will not get this extreme reaction from passive movement but feeling better, in general, is always welcome.

Other movements you can add can include doing pressure releases. Even everyday activity is adding movement to your body. Be sure to do pressure releases every 15 minutes when up. Manual pressure releases are great but using the tilt button on a power chair also is the movement of your body. Rolling in bed for pressure release can add movement to your body. If possible, roll a few extra times. Doing extra movement helps the skin and the bowel.

In lower-level injuries, you may have braces, walk with them. The swinging motion will stimulate the muscles of the abdomen. Walking with braces will increase your activity in your body and in your bowel. Many find walking with their braces to be a challenge, so they opt for wheelchair use to conserve their energy. This is a smart adaptive technique if fatigue is an issue. But do not give up on the braces. Use them once daily or every other day to move your body as an exercise.

Participate in sports, aquatic therapy, or anything that you enjoy doing to add movement that creates activity in your body. There are free videos for exercise with spinal cord injury on the web. Craig Hospital and Shepherd Center have great ones.

Sit up during your bowel program. Gravity is your bowel’s friend in that it helps drop the stool out of the bowel. If you do not have a commode chair, ask your healthcare provider to order one that meets your individual needs. This is not unusual equipment to have, so check your policy to be sure your payor will finance it. If not, ask for a letter of medical necessity to be provided by your healthcare professional.

Adjusting your diet is another way you can try to speed up your bowel through external actions. Give up processed foods and junk foods. That can be difficult to cut down over time. Eat just a small amount of them in extreme moderation. Instead, switch to fresh produce and fruit. These foods do not have the fiber already broken down for you, so your body does that in the bowel. Unprocessed foods contain a great deal of natural bulk and fiber. Some nutritional support drinks have added fiber varieties.

There is evidence that indicates that fiber laxatives can remove too much water from the stool, making it more difficult to pass if you cannot drink the amount of water required for them to work. Fiber laxatives have been the mainstay for individuals with reflexive bowel, but now it is noted that it may dry the stool too much, creating a more difficult and slower bowel program. This may not be your situation but if this seems like an issue for you, speak with your healthcare professional about alternatives and how to taper off fiber laxatives prior to stopping cold turkey. If your bowel has become accustomed to fiber laxatives, a transition time will need to be made. Slowly switching to less processed foods appears to be a better alternative. Foods that are rich in fiber include whole grains, beans, nuts, berries, oats, and crunchy vegetables like carrots and celery.

Pay attention to what you are drinking as well. Try to increase fluid intake slowly if your bladder program allows it. It takes fluid to move stool through your bowel, so you need to be well hydrated. Some drinks dehydrate the body. These include caffeine and alcohol. You can still enjoy these beverages but use them in moderation. Avoid sugary and sugar-free drinks as these add calories and salt, increase your blood sugar, and do not help with digestion. Foods that are high in fluid content, such as soups, can add to your fluid intake.

Have your healthcare provider review your medications for constipation effects. This should include all prescription, over-the-counter, supplements, recreational or other drugs you may have added along the course of your life. If a medication or combination of medications has the side effect of constipation, ask if there is an alternative. On the other hand, be sure to take stool softeners or other bowel-encouraging medications or supplements that work for you. Just be sure to report them on your medication list to ensure you are not compounding your slow bowel when you thought you were helping it.

Next week, other bowel issues will be discussed. Nurse Linda

Pediatric Consideration: Children’s bowels are generally faster in transit time due to their youth; however, this is not always the case with mobility issues. Keeping a child active can be a challenge. If possible, for your child, allow time outside of the wheelchair. Children like to roll around on the floor and play. Be sure their skin is protected to avoid pressure injury or rug burn.

Teens will need some encouragement to find a physical activity that they enjoy. Exposure to a variety of activities to find one they are interested in helps. There are many adaptive programs available in the community for children and teens.

Schools should also be enlisted to provide physical education programs that are adapted to your child's needs. If your child has an Individual Educational Plan (IEP), be sure it has a section about physical activity specifically listed in it. This is your contract for what will be provided and how it will be accomplished. Nurse Linda

Register for Nurse Linda's March 31 webinar on Bowel Care.

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.

This project was supported, in part, by grant number 90PRRC0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.