Managing your bowels efficiently is one of the most important aspects of living with a SCI, which is true no matter how old you are or how long you have been injured. If things go wrong with your bowel routine it can take over your every waking thought, disrupt your working life and affect your social life.

The human digestive system:

The ageing bowel 

With the advancing of the years your bowels will become sluggish and this affects the speed at which food passes through the gut, slowing the whole process down, which can then result in constipation. Constipation can be a short or long-term problem which may require you to alter your bowel management regime. 

Bowel care

There is more than one way to manage your bowels and the method you choose is most likely to be influenced by your level of injury; keep in mind that over time the method that best suits you could change.

The mention of bowels at a social gathering has the tendency to kill the conversation: Why? Bowel movements are a perfectly natural function that we all perform most days of our lives. 

The process of defaecation (passing a stool) involves several organs. Partially digested food passes from the small intestine into the large intestine (colon), where water is reabsorbed from the stool to make it more solid.  The action of the gut wall then passes the stool along until it reaches the rectum where signals tell you of the need to open your bowels: following SCI this signal is lost.

Disruption to bowel routine  

Your bowel routine can be affected by many things, such as:

• traveling or going on holiday
• hospitalisation
• a change in diet, especially when on holiday
• a change to your usual medication
• if your carer is ill and nobody comes to carry out bowel management

Causes of bowel accidents:

• illness, even a common cold
• urinary tract infections (UTI)
• not emptying the bowel properly
• medication: some medications can cause constipation whilst others can cause diarrhoea
• drinking more alcohol than is usual for you
• stress/anxiety.

Bowel problems associated with ageing

• constipation
• incontinence
• haemorrhoids - you can ask your Consultant to check this area at your annual health check. Your carer should advise you of the presence of haemorrhoids.  
• bleeding and pain - bleeding from the rectum can be the first sign of bowel cancer, but don’t panic, fresh blood appearing on toilet paper could be from internal or external haemorrhoids. Discuss anything suspicious as soon as possible with your GP or Spinal Injury Centre.
• bowel cancer - older people are at higher risk of bowel cancer. Does the health service in your country offer free screening for bowel cancer? Are there support organizations or charities which offer information and guidance on the subject?

Constipation and diarrhoea 

Causes of constipation:

• long-term medication, such as codeine-based painkillers
• some foods cause stools to become hard, such as dairy products and white bread  
• not enough/too much fibre in your diet
• not drinking enough water 
• missing meals, especially breakfast 
• change of routine e.g. when on holiday or admission to hospital

Causes of diarrhoea:

• illness, particularly food poisoning
• change in routine
• overindulgence in food and/or alcohol
• medication e.g. certain antibiotics or very strong laxatives

Changing your bowel regime

What options may be available:

Anal irrigation system:

There are several different products available on the market, which vary in administration techniques. Technical information and support is available by contacting the companies directly and/or healthcare services.  You/your carer will require training to use this method of bowel management from a healthcare professional, but from then on it can be self-administered.    

Colostomy:

People consider this option for a variety of reasons, but if you choose this system it will require a period of adjustment. You may have to alter your diet a little until the bowel settles down, but people have reported that it is the best thing they ever did and wish they had done it sooner. The main advantages of the colostomy seem to be the time saved and the maintaining of your independence. On the down side, some feel conscious of a smell, so finding the right products is essential; the adhesives can be messy and can cause skin irritation at first.

If you decide the colostomy is right for you, it is important to talk to someone who has successfully managed the transition. It is also important that you have easy access to a specialist Stoma Care Nurse who can offer advice and support.

Top Tips

• keeping a daily record when bowel problems occur will help you and your doctor to understand what is happening, and then decide what action to take.

• you may not be as agile as you once were, so care needs to be taken when transferring to and from the toilet. Also, bending forward to insert suppositories may put you at risk of falling. It may be time to rethink equipment needs such as hoists, or performing bowel care on the bed instead of over the toilet.

• some may find their bowel routine takes longer because of changes in dexterity. It may be time to consider professional help, or making some changes to your bowel routine.

• proper positioning on the toilet is important as an incorrect posture can cause the anal muscle to go into contraction, which will make defecation more difficult. The upper body should lean forward slightly so that the lower part of the colon is more straightened, thereby allowing the stool to pass more easily.

• you may make changes to your diet for health reasons but beware, even small changes to your eating habits can affect your bowels.

• try to eat the best quality food available, including plenty of vegetables and some fruit. You need fibre in your diet but too much can bung you up, and sufficient fluid  intake is essential to keep your bowel moving.

Seek the best advice available. This could be from healthcare professionals or you may have access to SCI forums where you can exchange views and information with other SCI people, or charities supporting people living with SCI.

Some medication, taken over a long period of time, may alter bowel function; you may need to discuss alternatives with your medical team.

Altering your bowel regime will require the exercise of patience and perseverance, it will probably take at least 2 weeks to establish your new regime effectively.  Try to change just one thing at a time, this will allow you to observe more easily where any problems arise.