Routine is key

The effects of paralysis on the digestive system and bowel can prove challenging and range from constipation to unexpected accidents. Thankfully, reports LIANA SHAW, most of these can be managed effectively by following a fixed routine

Paralysis disrupts the bowel system, with two main types of neurogenic bowel dysfunction commonly reported by people with SCI. An injury above the conus medullaris (at L1) results in upper motor neuron (UMN) bowel syndrome, whereas lower motor neuron (LMN) bowel syndrome occurs in injuries below L1.

Those with UMN, or hyperreflexic bowel, are prone to constipation and stool retention as a result of the anal sphincter remaining tight. This often requires the use of an outside stimulus such as a suppository or digital stimulation to promote bowel movement.

In contrast, LMN, or flaccid bowel, is marked by loss of stool movement (peristalsis) and slow stool propulsion, often leading to constipation and incontinence owing to a non-functioning anal sphincter.

According to the National Spinal Injuries Centre (NSIC), which is part of the NHS Buckinghamshire Hospitals group in the United Kingdom, the best way to prevent bowel accidents is to develop and follow a fixed routine.

Developing an individual bowel routine is a very personal and individual process that often involves some trial and error, especially in the early stages.

The NSIC advises keeping a record of daily bowel management outcomes, along with such details as oral
and rectal medication used, how long bowel movement takes and whether there have been episodes of
incontinence.

It further recommends that you consider the individual’s bowel habit before the injury, in other words, how frequently they used to have bowel movements and at what time of day. This information will be helpful in establishing a daily or alternate day routine at a time that will be most appropriate to their intended lifestyle.

The centre recommends that the bowel management process should not be hurried – adequate time should be allowed to promote a relaxed and complete evacuation. And in order to make use of the gastro-colic reflex, which kick-starts the bowel into action, a meal or hot drink should be taken first.

Laxatives that introduce the necessary fibre can help, especially when used in conjunction with stool softeners that are said to keep the water content of the stool higher.

People with neuromuscular-related paralysis typically also rely on suppositories containing the active ingredient bisacodyl.

Should these methods prove ineffective, an antegrade continence enema is an option, but this technique involves surgery to create an opening (stoma) in the abdomen that allows liquid to be introduced above the rectum, thereby effectively flushing fecal matter from the bowel.

A colostomy procedure is another surgical alternative to consider. This involves creating a permanent opening between the colon and the surface of the abdomen to which a stool bag is attached. Studies have shown that many people who have had colostomies are pleased and would not reverse the procedure.

However, general consensus is that the introduction of a regular, fixed routine in bowel maintenance can address many of these common challenges without the need to resort to surgery. Drinking enough fluid and following a healthy eating plan that includes fibre from cereal, fruit and vegetables are critically important, while activity and exercise also help to promote good bowel health.

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