This is a part of the Hot Topic podcast series from the Model Systems Knowledge Translation Center on Managing Bowel Function After Spinal Cord Injury. Denise G. Tate, Ph.D., researcher, discusses Barriers to Following a Bowel Program.

Denise G. Tate, Ph.D., ABPP

Professor and Associate Chair for Research

Co-Director, University of Michigan Spinal Cord Injury Model System

Yeah, a spinal cord injury can interfere with what you do in your life, who you are. So more at the beginning than so — people tend to be more resentful for what happened to them, and it’s difficult to adapt. As time goes by, as anything else in life that you may face, you get more used to it.

A loss of a child, a loss of a limb, a loss of function. So I think you will adapt, but in the beginning especially, it’s very, very traumatic. It’s very difficult to have to go on with life in different ways. And some people, even if they wanted to follow all the regimens that are recommended for a bowel program, for example, they might not be able to.

They might not have the help. They might not have the cognitive ability to remember everything that they have to do, especially if they are alone. They might not have the money to buy the medications that they need. So there are a number of factors that interfere with following up with the ideal regimen.

For example, patients on the issue of bladder, for example — patients need to cath themselves every three hours, so they have to wake up during the night to cath. Well, some patients with spinal cord injury have a lot of pain also. Chronic pain is a major issue for this population. So if you have to wake up, you just fell asleep, and you have to wake up now every three hours to do your bowel program or to do your bladder program, they might choose not to do so.

Because they need to survive in other ways. They need to rest. So sometimes it’s the attitude, but sometimes it’s really what surrounds us that makes it so difficult to follow the recommended routine. It’s beyond, I would say, their own control, what they can do and cannot do.

And that’s why I think for professionals, including myself, we need to really pay attention to that very closely with talking to patients about what outcomes are really relevant for them, what really matters to them.

It’s not just what we recommend; but if we recommend something that is going to interfere with their life activities in a daily way so that they can’t have a job, they can’t go play ball with their son or they can’t do certain things they really like to do, go to Las Vegas or whatever — we need to be conscious of that and work with them in ways that we can actually provide them with ways that are feasible for them that can still have some pleasure in their life activities. They can still have the right, you know, rest when they need to rest and go on with life as normal as possible.

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