How can a paralyzed person clear bowels at a specific time of day?
With paralysis, the pathway between the bowel and the brain is disrupted. This impairs the bowel’s signals to the brain about when and how to defecate.
The disruption level depends on the extent of damage and completeness of the spinal cord injury or illness.
Upper motor neuron bowel occurs with damage to the spinal cord at T-12 or higher and results from paralysis that damages the nerves that control the bowel.
When the rectum is full, defecation occurs reflexively and can lead to bowel accidents. This condition is also known as reflex bowel.
Lower motor neuron bowel results from damage to the spinal cord below T-12 and it impairs the defecation reflex and relaxes the anal sphincter muscle. When the bowel fills with stool, the sacral nerves try to send a signal to the spinal cord to defecate, but the injury disrupts the signal.
In this instance, the reflex to evacuate doesn’t happen and the sphincter muscle remains loose, a condition also known as flaccid bowel. Flaccid bowel can cause incontinence and constipation.
The Importance of a Bowel Management Program
For people with paralysis or limited mobility, it’s vital to have a regular bowel management program. The specific elements of each person’s program looks different depending on their unique situation. However, there are common methods employed to assist with defecation.
A bowel management program is a regular routine employed by individuals and caregivers to ensure stool is passed on a routine basis and fits a person’s schedule and lifestyle. A bowel movement routine effectively ‘trains’ the bowel to defecate at regular times and allows for maximum comfort, safety, convenience, and independence.
A bowel program is structured around several factors, including an individual’s schedule, prior bowel habits, and current lifestyle.
6 Factors that Affect a Regular Bowel Routine
There are several factors to consider when structuring a regular bowel routine, including:
Timing: Routine is essential and bowel programs are typically performed at the same time each day. While everyone’s schedule is different, it is common for it to occur first thing in the morning, before bedtime, and approximately 30 minutes following a meal.
Previous Bowel History: Each person’s version of what a ‘normal’ pattern of bowel movements looks like is different. Post paralysis, it’s beneficial to mimic prior bowel habits as much as possible.
A daily management program for one’s bowels is most common, but it’s advisable not to go more than 2-3 days without defection to reduce the risk of constipation and fecal impaction.
Privacy, Comfort, and Safety: People want to feel as comfortable as possible when going to the bathroom. For example, when sharing a bathroom, adjustments that allow for maximum privacy are essential.
The method of passing stool should also allow for optimum comfort and safety. To let gravity help, it’s best to be upright on a toilet seat, raised toilet seat, or commode chair if mobility and safety allow for it.
Nutrition and Hydration: Everything a person eats and drinks impacts their bowel schedule. It’s essential to consume a balanced, nutritious diet that is high in fiber.
Drinking plenty of water or other non-diuretic fluids also helps moisten stool and keep things moving. Avoiding foods high in fat, sodium, and sugar helps, as does moderate caffeine and alcohol intake.
Stress: Bowel movements are affected by stress, so when going through a challenging time, it’s vital to ensure that a bowel routine reflects this.
Side effects of stress like reduced or increased appetite and inability to relax can impact a bowel management routine. Modifications to the schedule should be made accordingly.
Fitness: Moving the body also helps move the bowels! A regular fitness routine helps keep things stable. For people with limited mobility, stretching and range of motion exercises are helpful.
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