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. Gianna Rodriguez, MD, researcher, discusses Medications, Techniques, and More.

Gianna Rodriguez, M.D.

Asst. Professor, Dept. of Physical Medicine and Rehabilitation

University of Michigan

The bowel program consists of medications, techniques for removing stool, diet, water intake or fluid intake, and timing of the bowel movement.

Medications are used to bring stool from the first portion of your colon to the last part of your colon to prepare for evacuation. There are two classes of medications that we use to do this. One is the osmotic, which bring water to the stool to make it easier to bring to the rectum, and two are stimulants, which helps stimulate the colon to bring the stool to the rectum.

Osmotic laxatives are your MiraLAX or your polyethylene glycol; your lactulose, which is a sugar based medication; your magnesium derivatives such as your magnesium citrate or your milk of magnesia; your Colace or your docusate, which is a stool softener.

There are various techniques in emptying the bowels, and one important one for people with spinal cord injury is what you call digital rectal stimulation. Digital rectal stimulation is small circular movements with your finger in your rectum about 10 times to allow a reflex to go to your spinal cord so that you can encourage rectal contractions to evacuate the stool. And this is done within, you know, a 10- to 20-minute duration so that you can have the stool fully evacuated.

There is also digital evacuation of stool, and the way this is done is inserting a finger into your rectum to just manually remove stool from the rectum. The enema is another way to evacuate your stool from your rectum by flushing out the stool adequately with, you know, 500 to 1,000 milliliters of warm water.

We encourage people with spinal cord injury to have a good amount of natural fiber in their diet. And what that means is a bowl of either fruits or vegetables per meal. This helps with the consistency of their stools. However, since we encourage high fiber intake, we need to ensure that the person with spinal cord injury also takes a good amount of non-caffeinated fluids of about 1.5 to 2 liters per day, because if they take less than this, then, you know, a high fiber diet can lead to constipation.

The ideal time for bowel care is in the morning, because after a sip of fluid or breakfast, it induces the gastrocolic reflex, which helps with moving stool through your colon. However, if they are not able to do a morning bowel care, then they can always do it in the afternoon or the evening after a meal and still maximize the gastrocolic reflex.

Bowel care needs to be done the same time every day so that this leads to habituation. It is also important so that medications can be timed and so that a routine can be set in place.

A typical bowel program might include both an osmotic laxative like MiraLAX, a stimulant medication like Senna, and usually we prescribe this to be taken at night to prepare the colons for evacuation in the morning, okay? In the morning for bowel care, then we ask the patient to use either an Enemeez, mini enema, or the bisacodyl or Magic Bullet suppository to be inserted about maybe half hour prior to their breakfast and maybe about half hour after the meal or breakfast then we have the person with spinal cord injury prepare themselves for bowel evacuation. And bowel evacuation might involve either digital rectal stimulation or digital evacuation of stool or a water enema.

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