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Spinal Cord Injury Information
I sincerely hope the information presented will be useful and help you and yours cope with this devastating injury.
If you do not find a subject shown here, please let me know and I will certainly try to research the information and present it on this website in continuing updates.
| Jerry's Dad |
| Geo. M. Haney Jr. |
SCI INFORMATION, Hygiene
This important section is devoted to hygiene, and includes information and tips on daily and SCI specific hygiene, our skin and how to care for it, how to protect our skin from injury, suggestions for the alleviation and treatment of pressure sores, bladder and bowel programs.
Bowel Program
The bowel is the last part of your digestive system. The waste products of eating are stored in it until you wish to have a bowel movement. Large intestines and colon are other names for the bowel.
Your diet, the amount of exercise you do, and the regularity of your bowel movements play an important role in keeping you healthy. The following is a description of the digestive system and how some parts can affect your bowel movements. (See figure)
The Digestive System |
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Mouth: As you chew, saliva mixes with broken-up pieces of food. By eating a well-balanced diet high in fiber, there will be enough bulk to make passage through the system run smoothly. Esophagus: This is a hollow passageway through which food reaches the stomach. Stomach: Digestive juices break down the food into carbohydrates, fats, proteins, and other end products. Small intestine: As the watery mixture moves through here, nutrients are absorbed into the blood stream. |
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Bowel (large intestine): Water is absorbed back into the body as the remaining by-products of digestion move through the bowel. SCI may affect the last half of the large intestine causing slow, uncoordinated passage of stool. Rectum: When stool reaches the rectum, you get the urge to have a bowel movement. If you have a lack of feeling in your rectum, you will not get this urge. Anus: This circular muscle is the sphincter (gate) of your rectum. When you relax this muscle, you can have a bowel movement. When you tighten it, you can prevent having a bowel movement. |
The management of your bowels after a spinal cord injury is possible with planning and a bowel program. Keeping your bowel emptied on a regularly scheduled basis and not allowing chronic over distention is the goal. Using an abdominal binder to support the abdomen may be helpful.
To stimulate peristalsis (wave-like movement of the intestines), you may use a rectal suppository and/or digital stimulation of the anus muscle. This bowel program can be done on a commode, on a toilet, or in bed with pads.
The well-planned bowel program will:
Establish a regular pattern that will fit into a daily schedule. Your bowel program can be every day, every other day, or every three days. In the first weeks after your spinal cord injury, your bowel program will be every day.
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Eat a well-balanced diet with high-fiber foods.
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Have privacy.
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Be comfortable.
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Exercise (range-of-motion exercises).
Do not do the following if you desire a good bowel program:
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Use large enemas, because they decrease normal bowel muscle tone. Mini-enemas may be prescribed.
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Take strong oral laxatives routinely.
The supplies needed for the well-planned bowel program are:
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Suppository inserter (if you need one).
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Suppository or mini-enema.
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Lubricating jelly Waterproof pads.
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Gloves
HOW TO PERFORM A BOWEL PROGRAM
Do your bowel program after a meal or hot drink because this stimulates peristalsis to empty your rectum.
Insert a well-lubricated suppository high up into your rectum with a gloved finger or adaptive device, placing it right next to the intestinal wall (See figure). Remove any stool in rectum first if it is in the way of placing the suppository. |
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Transfer to a toilet or commode, if possible, because gravity helps with emptying.
Wait 10 minutes after insertion. Then do digital stimulation by inserting a lubricated gloved finger or adaptive device into your rectum. With a circular motion, massage the anal muscle until it relaxes (15-60 seconds).
You may need to do digital stimulation every 5-10 minutes, allowing stool to pass through the anal muscle.
Do a final check with lubricated glove or adaptive device to determine if rectum is empty.
Things That Can Affect Your Bowel Program
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Exercise stimulates peristalsis. Range of motion can be done before or after inserting the suppository and before digital stimulation.
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Some medications can affect peristalsis. For example, narcotics or anticholinergics may slow down peristalsis and cause constipation.
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Emotional stress may cause either constipation or diarrhea.
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Change in time of bowel program may lead to bowel accidents.
The table below shows how diet can harden or soften your stool.
Food Group |
Foods That Harden Stools |
Foods That Soften Stools |
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Milk |
Milk, yogurt made without fruit, cheese, cottage cheese, ice cream. |
Yogurt with seeds or fruit |
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Bread and Cereal |
Enriched white bread or rolls, saltine crackers, refined cereals, pancakes, waffles, bagels, biscuits, white rice, enriched noodles |
Whole grain breads and cereals |
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Fruits and Vegetables |
Strained fruit juice, apple sauce, potatoes without the skins |
All vegetable except potatoes without the skin |
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Meat |
Any meat, fish, or poultry |
Nuts, dried beans, peas, seeds, lentils, chunky peanut butter |
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| Fats | None |
Any |
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| Desserts and Seeets | Any without seeds or fruit |
Any made with cracked wheat, seeds, or fruit |
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| Soups | Any creamed or broth-based without begetables, beans, or lentils |
Soups with vegetables, beans, or lentils |
Having troubles? Read the following for help:
Diarrhea - Diarrhea is a loose stool, which may cause unplanned bowel movements and accidents. It can be caused by spicy foods or foods containing caffeine, such as, coffee, tea, cocoa, or cola drinks; Antibiotics; Over use of laxatives / bowel softeners; Severe constipation; Flu or intestinal infection; Psychological stress. The following are suggestions to solve the problem: Eat the recommended foods for when you have diarrhea (See table); Stop any laxatives until diarrhea clears up; Stop stool softeners temporarily, then begin after diarrhea is over, adjusting dose to get the stool consistency you want; Evaluate whether there is a chance that you have an impaction or blockage: no stools, hard stools, or small, hard bowel movements within the last week. One of the most common causes of diarrhea is an impaction where only liquid and soft stool can get past the impaction. Call your health care provider if the problem persists for more than 24 hours. After diarrhea clears up, re-evaluate your bowel program, use of stool softeners, diet, etc.
Constipation - Constipation is a condition of hard, infrequent stools and typically is caused by: Lack of a regularly scheduled bowel program; Incomplete emptying with your bowel program; Diet low in fiber; Bedrest or low-physical activity levels; Medications: Narcotics, iron, aluminum hydroxide (Amphogel). To resolve the problem try: Eating foods high in fiber to help prevent constipation; Increase activity — range of motion; Take psyllium hydro-mucilloid (Metamucil); Take docusate sodium (DOSS); Drink plenty of fluids as tolerated by bladder program.
Impaction - An impaction is a partial or complete blockage in the intestine by stool. The typical causes for this condition are the same as Constipation. To normal solution is to: Manually remove stool in rectum; and / or call your health care provider for assistance.
Rectal Bleeding - Rectal bleeding is seen as bright red blood on your stool, toilet paper, or glove. It is normally caused by: Hemorrhoids; Hard stools (constipation); Rectal fissures (cracks or breaks in the skin); Traumatic digital stimulation of anus (long fingernails damaging the rectum during digital stimulation). To solve this problem try to: Soften stools with DOSS and Metamucil; Gentle digital stimulation without trauma; If the rectal bleeding continues for two to three bowel programs, call you health care provider.
Autonomic Dysreflexia – This is so important it will be covered completely in the Medical section. This condition simply stated can be anything that can cause pain, such as: Hemorrhoids or fissures; Full or overdistended bowel (constipation, skipped bowel program, impaction); Rough digital stimulation. Alleviation of the potential problems can be solved by: Regularly scheduled bowel programs with adequate emptying; (You may have to increase the frequency of bowel programs you do); Comfortable positioning during bowel program; Anesthetic ointment applied to anal area 5-10-minutes before suppository insertion and digital stimulation;
No Bowel Movements - If bowel movements have not occurred for two to three bowel programs, the possible causes are: Constipation; Impaction. Try to determine the cause as a means of resolution and if assistance is required, call your health care provider.
Excessive Gas – Excess gas is normally caused by: Gas forming foods (See table); Constipation; Swallowing air while eating or drinking; More than normal bacterial breakdown of bowel contents. Possible solutions are: Eat your food slowly, chew with your mouth closed, and avoid gulping food; Certain foods may give you gas. Do trial periods of omitting these foods one at a time to enable you to determine which, if any, cause you to have gas; Begin a bowel program.
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