Tips and Timesavers for your Bowel Program

Posted by Nurse Linda in Life After Paralysis on April 07, 2021 # Health

Managing neurogenic bowel is critical to your health. Neurogenic bowel is the result of miscommunication by the nerves to signal bowel function, alert you that you need to evacuate the bowel and controlled emptying. It occurs in individuals with spinal cord injury and may be present in individuals who have a brain injury or other neurologic medical conditions.bowel graphic

The consequences of not addressing neurogenic bowel issues include non-removal of body waste leading to impaction, overfilling the bowel, and back up of stool into the stomach with vomiting stool. Also, stool can be partially expelled from the body or incontinence of stool, leading to social embarrassment and skin breakdown. Uncontrolled stool expulsion can infect wounds as well as a source of urinary tract infections.

You can control your bowel movements through a bowel management program. For most individuals, this process is initiated and does well. Establishing a well-functioning bowel program is not an overnight process. To really develop an effective bowel program takes an average of about six weeks. For others, it takes a bit longer. This is something you really must work toward. It is a process that becomes routine; however, adjustments will need to be made as a person ages.

There are a couple of bowel program guidelines that need to be followed. First, with neurogenic bowel, you must perform a bowel program. Typically, bowel programs for reflexive bowels or upper motor neuron injury bowels (those usually in the cervical or thoracic levels) are done every other day. It is also critically important to perform the bowel program at a specific time. Now, this can be a drag, but it is necessary to your success.

Individuals with a flaccid bowel or lower motor neuron injury (typically with lumbar or sacral injury) should manually evacuate their bowels. Some will do this every day or every other day. Some individuals will check their bowel at each toileting to remove stool that is present. Over time, you will recognize your transit time and remove stool when needed.

The second guideline is timing. Bowel programs used to be called bowel training. There were many reasons for changing this process's title, but if you think about your bowel program as training your bowel, it makes some sense. Training your bowel means you are creating a process where you teach your bowel to empty at a regular time. This helps control the bowel to conform to your program. Therefore, timing is a strict guideline.

The good news is you can select the time for your bowel program. If you have time in the morning when the gastrocolic reflex is most active, those with a reflexive bowel should perform the bowel program at the same time every other morning. You may find this time works well for manual removal every morning for a flaccid bowel, but that is individual to the person. If you have more free time in the evening, you can still stimulate the gastrocolic reflex and have success at that time. The issue is sticking to the same schedule. This is more critical than you might think, but it all goes back to 'training' the bowel. Time schedules can be adjusted, but it takes weeks to re-regulate to a new schedule. Changing your bowel program time is not something that should be done without a great deal of planning.

There are some tips and timesavers that will help you organize your bowel program to your advantage. These are ideas that you should think about but not enact all at once. If your bowel program is functioning well, you might just want to keep these ideas in mind should you need them later. For others, they are reading this blog because they have issues now. You might be already doing some of these activities. Hopefully, there will be a few ideas that will help you improve your bowel program.

It is important not to change aids in your bowel program too quickly or all at once. If you have a day of constipation, think about your fluid intake, diet and activity. All too often, we see people who have some constipation, so they take a stool softener. Oops, over a few days, their stool is too loose, so they start with an antidiarrheal. Oops, too hard, an increase in stool softener or another product added. Oops, too loose, and on it goes. People who are taking too many bowel aids end up slowing the bowel program.

Always review your bowel product intake. Look at changes in your fluids, diet, activity, new medications, and supplements that treat other issues. Changes in your lifestyle that are good and not so good can affect your bowel function. When making a change to your bowel program enhancements, just change one thing at a time. Wait for an effect before jumping ahead to making other changes. Moving too quickly with multiple changes is a recipe for disaster with the bowels.

Fluid intake is critical to bowel function. Research indicates that most individuals with or without neurogenic bowel are dehydrated. Increasing your fluid intake, especially with water, is helpful to a successful bowel program. The bowel works by removing fluid from waste to form a stool. The slower the bowel or, the longer stool is left in the rectum, the drier it becomes. Stool should be moist until the point of exit from your body. Dry stool is hard to pass and difficult to remove manually.

Do not start drinking more fluid immediately. Gradually build up over time until you see results in the quality of your stool. Drinking too much too fast is difficult on your body systems. Start by an increase by a swallow or two over a day. Even that small amount can make a difference. For individuals who control their fluid intake, this should not be attempted. You might be controlling your fluids due to a bladder management program where increased or overloading fluids can affect your kidney function. Also, those with cardiac issues or those with extreme edema should be cautious about increasing fluids. Everyone should check with their healthcare provider about how to increase fluids. A hidden healthcare issue could make increasing fluids disastrous.

Foods should be high in roughage. Most individuals, even with neurogenic bowel, will get enough fiber from their diet. You may need to adjust what you eat by adding more fresh produce, beans, nuts and seeds. Some cereals such as Kashi, Muesli and Grapenuts have a positive effect on bowel roughage. Check the product content label to be sure you are not getting too much sugar. Leave processed food behind. Find out what affects your bowel in a positive direction and eat those products.

Some individuals use fiber to increase their bowel function. Fiber helps move stool through the bowel. It gives the intestines something bulky to 'grab on to,' which pushes waste along. However, it has been found that most individuals who take fiber products do not drink the full 8 ounces of water that is needed to keep the stool moist with these products. Some will divide the product's daily amount into increments taken throughout the day to ensure water content. If you are not taking in the recommended amount of water to make the product work, you are creating an even drier stool that is harder to pass: a good intention but a negative outcome.

Stimulating the gastrocolic reflex is critical to successful bowel movements with or without neurogenic bowel. Be sure to take advantage of it. The gastrocolic reflex is natural in the body. When food is taken in, the gastrocolic reflex tells the bowel to get working. If your stomach and bowel have been working slower, such as when you sleep, eating something will trigger the bowel's gastrocolic reflex to get increased movement in about 20 minutes. This is the reason so many people (but not all) have a bowel movement in the morning after breakfast. A hot beverage further stimulates the gastrocolic reflex.

If you desire to perform your bowel program in the evening or another time of day, do so about 20 minutes after eating dinner or after a small snack before doing the bowel program. The gastrocolic reflex will not be quite as strong, but it will still be stimulated enough to work for you. Adding a hot beverage, even hot water, will help as well.

Activity is how the body works. After an issue that affects movement in the body, activity in the injured area is not provided. But you can add movement to your body by moving your limbs, moving your body, or having someone move it for you. Range of motion to your lower extremities can help the muscles in the legs stimulate the muscles in your abdomen. Bowel movement is based a lot on the movement of your abdominal muscles.

If you can increase your activity through exercise, you are furthering your bowel movement goals. Individuals that use braces are stimulating their bodies for purposeful activities as well as for exercise. Any physical activity that you can provide to your body to stimulate those abdominal muscles is helpful.

Gravity is your friend. Standing is not a movement activity, but it has been shown to help facilitate bowel activity. Standing as an activity or sitting up for the bowel program is helpful in using gravity to bring stool out of your body. Try to obtain a standing frame or commode chair to accommodate a more efficient bowel program. Be sure to use the commode chair only for evacuation, no waiting time, and to avoid weight being placed through an unsupported rectum.

Avoid complications in the rectal area by using a well-lubricated, gloved finger for the bowel program. This is not a time to be thrifty with the lubricant. Use a water-based lubricant generously. Internally, the bowel is moist. Use of a dry stimulation tears at the delicate tissue.

These are just a few ideas about enhancing your bowel program. Do you have others? Please let the community know by responding to this blog. What works for you might be just the thing someone who is struggling with their bowel program needs. Your contribution can make a difference in someone's life. Nurse Linda

Pediatric Consideration: Most of these suggestions will work for children as well. Be extra careful not to overdo changes in fluids, diet and activity as slight changes can affect children greatly. Always check with your healthcare professional to be sure the change or any addition is right for your child.

As a child becomes older and able to sit with support, start performing the bowel program with the child upright for evacuation. This takes advantage of gravity for evacuation of the bowel. Many people tend to continue to use side-lying for the bowel program for children but taking advantage of gravity and movement for evacuation improves the results. 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.