Bowel Function After SCI Infocomic

A spinal cord injury can lead to bowel problems. This comic talks about what you need know to control bowel movements after a spinal cord injury.

Some people with SCI may experience problems moving waste through their colon, passing a stool when they do not want to, abdominal pain, and anxiety about not being able to control bowel movements in public. The comic explains:

  • What a bowel program is
  • How a bowel program may help people with SCI control bowel movements
  • The steps involved in maintaining a bowel program
  • The importance of maintaining healthy bowel function

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BOWEL FUNCTION AFTER SPINAL CORD INJURY

Seated in his wheelchair, Alex is lifting a small weight with his arm. A physical therapist is assisting him.

Alex recently had a spinal cord injury (SCI) and is receiving comprehensive treatment and care at a rehabilitation hospital. Though there are many different steps in the recovery process after SCI, one important step is ensuring healthy bowel function. Dr. Williams tells Alex that bowel problems after SCI are common.

After his physical therapy session, Alex then sees his doctor, Dr. Williams, who is sitting on a chair next to him. Standing behind Alex is his wife in a show of support. Dr. Williams says, Nice to see you today, Alex! Let’s discuss bowel function after SCI.

 

Dr. Williams tells Alex that bowel function after SCI may include...

 

...passing a stool when you don’t want to or having a hard time passing a stool. For example, Alex, his wife, and daughter are at a baseball game. His daughter is standing on her chair about to catch a flyball. Alex has a look of discomfort on his face and is clenching his stomach. Alex is thinking, Ugh…not now.

...feeling fuller than normal when eating or eating less than usual. For example, Alex’s daughter is holding a pizza in front of him. She says, Dad, aren’t you hungry? Alex looks frustrated.

...feeling anxiety about controlling bowel movements in public. This may make you not want to do things outside. For example, it is a beautiful day outside, but Alex is inside his house looking out the window. He thinks, Sigh…Another beautiful day outside…

To help with bowel function, your doctor may suggest a plan to retrain your body to have regular bowel movements. A doctor or nurse designs this plan, called a bowel program, just for you.

Dr. Williams tells Alex, I’m going to recommend that you start a bowel program. With a curious look, Alex replies, What does that include?

Pointing to a blackboard, Dr. Williams tells Alex that a bowel program includes the following goals: (1) regular planned bowel movements; (2) moderate to large stool outputs per each bowel movement; (3) bowel movements at the same time of day (A.M. or P.M.); (4) complete emptying of the rectal vault with every bowel movement; (5) stools that are soft, formed, and bulky; (6) completing bowel care within 30 minutes (at most within one hour); (7) no episodes of fecal incontinence or unplanned bowel movements.

A bowel program has four parts:

The first part is timing, which requires following your bowel program every day or every other day. This will help decrease stool incontinence. For example, Alex is crossing another day off the calendar for successfully following his plan.

The second part is diet and fluids, which requires eating healthy (especially natural fiber from fruits and vegetables) and drinking plenty of fluids for bowel health. For example, Alex is at the table with his daughter and dog. Alex and his daughter are happily eating grapes, and Alex also has a glass of water.

The third part is medicine. Your doctor may suggest that you take medicine to soften your stool. Medicines that reduce pain, stop bladder spasms, and treat depression my cause constipation. Make sure to discuss medicine options with your doctor. For example, Alex is holding up a few prescription bottles.

The fourth part is techniques. For example, Alex is in bed reading a book entitled, Techniques. His wife is looking over his shoulder reading along with him.

Several techniques can help you have a bowel movement and empty the rectum. You can do the following alone or with help from a caregiver or nursing aid: Digital rectal stimulation: move your finger in a small, gentle circular motion around the rectum. Digital removal of stool: Use your finger to remove stool from the rectum. This will speed up the ability to empty the rectum. Enemas/suppositories: Use a device to flush warm water into your rectum (enemas), which will help empty it of stool, or use other bowel evacuation devices (such as suppositories). Bowel management techniques may work differently for different people. Learning what works for you may take some trial and error.

 

Alex also meets with a nurse to help him practice different bowel movement techniques. The nurse says, Hi! I’m Nurse Meiling. What technique would you like to try today to help have a bowel movement?

Dr. Williams tells Alex that untreated bowel problems can lead to other health problems. These include partial paralysis of the stomach, gas pain, and chronic heartburn. Other problems include worsening pain, hemorrhoids, nausea, and a decreased sense of well-being.

Dr. Williams tells Alex, This is why treating bowel problems is so important.

Alex asks, What if a bowel program doesn’t work for me?

Dr. Williams tells Alex that it may take time to find a bowel program that works best for him. She also tells Alex that his bowel program could change over time. Many individuals with SCI have success with bowel programs. Other options are available if the program doesn’t work. Options include two types of surgeries:

The first surgery option is a colostomy in which the colon is attached to the abdominal wall through a hole called a stoma. A bag is attached to the stoma. Stools pass into the bag instead of the rectum. You or a caregiver empty and change the bag as needed.

The second surgery option is antegrade continence enema in which the abdominal wall is opened to create a path to the colon. You or a caregiver place an enema catheter through the stoma each day to flush stool out of the colon with tap water.

However, Dr. Williams tells Alex, Let’s see how your plan works out. A good bowel program with regular and consistent stool is key to successful bowel management.

Alex and his wife both look and feel reassured.

Source: The Content of this infocomic has been adapted from the factsheet Bowel Function After Spinal Cord Injury, which was developed by Gianna M. Rodriguez, M.D., in collaboration with the Model Systems Knowledge Translation Center. It was illustrated by Grant Corley. Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the SCI Model System directors.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this infocomic were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this infocomic do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the federal government.

Neither SCI Model Systems, MSKTC, or NIDILRR has examined, reviewed, or tested any product or device cited in the infocomic. None of the parties involved make endorsement, representation, or warranty as to any product or device contained in this infocomic.

Copyright 2020 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials. Image of the MSKTC Logo. Image of the SCIMS Logo.

Related Resources for Bowel Function After SCI

To learn more, check out our resources page about bowel function after SCI.

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