Bowel management for spinal cord injury

What is meant by bowel management in spinal cord injury?

Depending on the location of the injury, a spinal cord injury can affect bowel continence. Spinal cord damage in the lumbar vertebrae leads to flaccid paralysis of the anal sphincter, which means that it is permanently dilated. However, if the spinal cord injury is located higher towards the head, the muscle tone of the sphincter is increased or even spastic.

As voluntary control of the sphincter is no longer possible and the sensation of the urge to defecate is impaired or even eliminated, patients with spinal cord injury often experience involuntary defecation.

The term bowel management covers both conservative and medication-based measures designed to achieve regular and planned bowel emptying.

Why is bowel management important in spinal cord injury?

Reflexive, involuntary bowel movements present an extremely distressing situation for those affected. Fear of uncontrolled bowel movements often leads to avoiding public places and other people. However, this social isolation further exacerbates the psychological burden.

In addition, a lack of bowel management can also have physical consequences. An unregulated bowel pattern and chronic incomplete bowel emptying can lead to constipation, which can trigger the following symptoms in patients with tetraplegia:

• pain
• flatulence
• involuntary defecation
• paradoxical diarrhea
• reflectory bladder dysfunction
• loss of appetite
• shortness of breath

In the worst cases, an intestinal obstruction (ileus) can develop, which can lead to circulatory shock or a bacterial sepsis. This is a life-threatening situation that requires immediate surgery.

To avoid the physical and psychological complications of uncontrolled bowel emptying, bowel management is an essential part of the rehabilitation of people with spinal cord injury.

What is the goal of bowel management?

The goal of consistent bowel management is to ensure that the bowel is emptied regularly according to a fixed schedule, preventing unplanned bowel movements. The aim is to achieve balanced bowel function, avoiding diarrhea or constipation.

Successful bowel management helps individuals participate more actively in social life, has a positive impact on mental well-being, and also saves time. This can significantly improve the overall quality of life.

Which methods and approaches are there for bowel management? 

In spinal shock, i.e. the acute phase of spinal cord injury, there is a high risk of bowel obstruction. This can be prevented by administering parasympathomimetics, which are drugs that amongst other functions, help to activate bowel function, as well as regular bowel emptying.

Over time, the bowel function will normalize to a certain extent. It is now important to establish a fixed routine through bowel training. This means that the bowel should be emptied once or twice a day at the same time every day. Food intake should also occur at set times and the amount of food and liquid consumed each day should be similar.

If bowel emptying takes place about half an hour after eating, it is supported by the gastrocolic reflex. This reflex results in an increased urge to defecate - also in healthy people - when the stomach is stretched after eating. A colon massage, in which the course of the large intestine is stroked over the abdominal wall, can also stimulate bowel movements at the right time.

If necessary, the evacuation reflex can be triggered by lightly stretching the sphincter with a gloved finger.

Regular bowel movements can be trained by adhering consistently to the schedule.

Changes, such as a change in diet or postponing bowel movements, must be introduced carefully and gradually in order not to upset the bowel pattern and avoid constipation and involuntary bowel movements.

Moreover, people with spinal cord injuries should also make sure that they drink at least two liters of fluid a day and consume a sufficient amount of fiber, e.g. whole grain products, fruit and vegetables, as these stimulate healthy bowel function.

Patients who are susceptible to constipation can improve the consistency of their stools by consuming bulking agents like wheat bran or linseed. If this is not enough, various laxatives are also available, which can be taken either as suppositories or orally as powder, drops or tablets.

Patient education is also very important. Affected individuals should be well informed about the various approaches to bowel management and be confident in the use of both medication and supportive measures, such as sphincter stimulation and colon massage, so that they can use them on their own.

What role does the psychological component play in bowel management for spinal cord injury?

The psychological state has a significant impact on digestive functions, as experienced even by individuals without spinal cord injuries. Stressful situations can lead to nausea, heartburn, constipation, bloating, or diarrhea.

Therefore, in bowel management for spinal cord injuries, it is especially important to conduct scheduled bowel evacuations without time pressure, in a calm environment, and, if possible, in familiar surroundings. Conversely, a regularly functioning bowel with a healthy bacterial flora positively impacts mental well-being and other neural functions.

Which doctors & clinics specialize in bowel management for spinal cord injuries

A spinal cord injury is a very complex condition that requires treatment by physicians from various specialties. Therefore, there are interdisciplinary clinics specializing in the diagnosis, acute treatment, and rehabilitation of individuals with spinal cord syndromes. In these settings, departments such as neurology, trauma surgery, anesthesiology, internal medicine, and rehabilitation medicine collaborate with psychologists, therapists, and specialized nursing staff.

Bowel management is an essential component of the cross-disciplinary rehabilitative treatment.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of spinal cord injury. They are looking forward to and are ready to address your questions and treatment requests.