Patty and Roberta, known as the Rollin’ RNs, discuss an important health topic that relates to the world of spinal cord injury — bowel care. The nurses provide information on the anatomy of the digestive system, health benefits of a bowel program, and methods of evacuating the bowel.
Human Digestive System
The parts of the digestive system that are concerned with a bowel program is the small intestine, large intestine, rectum, and anus. The nurses state, “The small intestine is the section of your digestive tract where the majority of food digestion and nutrient absorption takes place. The main function of the large intestine is to absorb water and remove solid waste from the body. The key role of the rectum is to act as a storehouse for feces. The anus is the opening where the gastrointestinal tract ends and exits the body.” Did you know that the human body takes 16 hours to complete the digestion of food?
The Importance of Fiber In A Balanced Diet
Including fiber with plenty of water consumption in your diet is extremely important. A high fiber diet has many benefits for a person with an SCI because it normalizes bowel movements. Dietary fiber increases the weight and size of your stool and softens it making it easier to pass avoiding constipation. Consuming fiber helps maintain bowel health. “A high-fiber diet may lower your risk of developing hemorrhoids and small pouches in your colon (diverticular disease),” says the RN’s.
Soluble fiber found in beans, oats, flaxseed and oat bran may help lower total blood cholesterol levels by lowering low-density lipoprotein, which is considered “bad” cholesterol. Soluble fiber can also help people with diabetes as it can aid in slowing the absorption of sugar and help improve blood sugar levels. Eating a high fiber diet can also help with maintaining a healthy weight. “High-fiber foods tend to be more filling than low-fiber foods, so you’re likely to eat less and stay satisfied longer. And high-fiber foods tend to take longer to eat and to be less “energy dense,” which means they have fewer calories for the same volume of food.”
“But why should we drink lots of water to prevent constipation? The intestines are greedy little fellows, they will take the water one way or the other.”
Drinking large amounts of water helps prevent constipation because as the nurses say “the food you eat makes its way from your stomach to the large intestine or colon. If you don’t have enough water in your body already, the large intestine soaks up water from your food waste.”
Timing Bowel Program
It’s important to set the time for your bowel program that works best for your body and lifestyle. This can be daily, every other day, etc. whatever works best for you and your schedule. The nurses say, “It’s easier for the body to do a bowel program sitting on the toilet or shower chair to let gravity help out but if laying in the bed, lay on the left side as this works best with our anatomy.”
Methods For Evacuating Bowels
The nurses list the following methods that can be used for having an effective bowel movement:
- Enemas- An enema is used to clean out the lower portion of the bowel, and are usually the last resort to alleviating constipation. “Enemas are not without risks, especially to spinal cord injured. Forcing an enema into the rectum can cause irritation and damage to surrounding tissue. Never force the tube into the rectum,” states the RNs.
- Stool Softeners- Stool softeners soften the stool making it is easier to pass. Stool softeners come as a capsule, tablet, liquid, and syrup to take by mouth. They are often taken at bedtime or twelve hours before your bowel program. It is important to take them as prescribed by your doctor and to contact them if problems arise.
- Magic Bullet Suppository- Magic Bullet is a product is used to treat constipation. Bisacodyl is a stimulant laxative that works by increasing the amount of fluid/salts in the intestines. It usually takes fifteen to sixty minutes for the suppository to work. However, the Magic Bullet does have side effects such as rectal irritation/burning/itching, mild abdominal discomfort/cramps, and nausea.
- Digital Stimulation- Digital stimulation involves moving the finger around in a circular motion inside the rectum. This movement stimulates the bowel reflex and rectal muscles open allowing the stool to leave the body. Pressure may be felt in the rectal area, but it should not be painful. The nurses suggest stimulation should be done at the same time every day or every other day depending on the individual. Make sure that stimulation is slow to avoid autonomic dysreflexia.
Medications To Avoid
There are medications that can cause constipation such as Imodium and pain medication.
Imodium is used to treat sudden diarrhea. It works by slowing down the movement of the gut, decreasing the number of bowel movements and making the stool less watery. The nurses say that if you have to take Imodium do so carefully. They suggest the medication should be avoided entirely for those newly injured. “Avoid fried, spicy foods and review your past 24-hour diet. You may find out the diarrhea was started by your previous food choices. Try BRAT diet, Bananas, Rice, Applesauce, and Toast diet to see if diarrhea slows down or subsides prior to taking Imodium.”
Pain medication (opioids) are known to cause constipation. The nurses researched pain medication on Web MD and found, “Scientists think (constipation is caused) because your gut doesn’t get used to opioids the way the rest of your body does. The longer you take the drug, the bigger the chance it will block you up.”
Take your time with finding the right bowel program that works for you. Accidents will happen, don’t be afraid to make adjustments!
“Finding a bowel program that works best for you or your loved one takes time. Just because one program works for someone else doesn’t mean it would work for you. “
It is important to talk with your doctor on what method would work best for you and your body.
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