The only good bowel is an empty one. GEORGE LOUW investigates the challenges and solutions available for bowel management
I can live with my paralysis. I can cope with the limitations in my mobility. My wheelchair and the hand controls in my car liberate me. My paralysis has become a part of what defines me as a person.
However, as my paralysis progressed with time, new complications started to surface and progressively worsen. My bladder behaves like a teenager. If it does not want to go, it refuses to go. But if it wants to go, it demands immediate attention.
However, I have learned to manage my bladder and we have a reasonable understanding. But, recently, my bowels also started behaving mischievously. That is a totally new ball game.
It saps your confidence. There is a loss of self-esteem. Self-inflicted social isolation sets in. Life becomes miserable … but, as with my bladder, I have come to know and understand my bowel triggers and I am getting to grips with it. However,itremains a challenge.
My own experience prompted this article. So, I asked friends (no real names are used) with quadriplegia and paraplegia how they experienced the shenanigans imposed on them by their bowels and what they did to overcome this. I will tell their stories and then have a look at various non-bowel routine options that are available out there for those who are truly shitty- shenanigan-gatvol.
Conditions that cause spinal damage often cause the nerves that coordinate bladder and bowel function to become scrambled. Depending on the nature of the damage, the fallout is so variable that each person essentially is unique, ranging from extreme constipation to uncontrollable faecal incontinence, with all kinds of in-between hassles.
That is why there are so many different bowel routines. In the end, our experiences and the ways we deal with them, are almost unique. As you will see from the stories that were shared with me and what I discovered in my reading.
For more on bowel routines and the functionality of normal and neurogenic bowels, visit the Rolling Inspirationwebsite and download issue 1 of 2019.
Gerald
I became a quadriplegic after a motorcar accident as a teenager. My bowel routine every second night was managed by family members. The process was a time consuming, embarrassing and unpleasant battle, which was emotionally draining for me and my family.
After being a slave to my bowel routine for five years we came to the decision that it could no longer carry on like this. A few years earlier my father had a colostomy as part of the management of colon cancer. He coped very well with it; so when I said I wanted to follow suite, my family were all for it.
The surgery was a breeze and the training and support provided by the stoma therapist was fantastic. My medical aid paid for the surgery and the stoma products. After the initial disconcerting experience of seeing Mick Jagger’s lips protruding from my side, I soon got into the swing of things and today, twenty four years later, I have not regretted my decision at all.
“The surgery was a breeze and the training and support provided fantastic”
Tshepo
Ageing as a person with a spinal cord injury has been challenging for me as I am in my thirty seventh year as a quadriplegic.
I now notice my bowels are more sluggish than before and my routine not as effective as I have experienced over all these years.
Some Google searches, asking around, and the leap of faith made me change my bowel routine from the usual laxative and suppository every second day to doing bowel irrigation.
Now, hey presto, everything is back on track. I feel confident again and I am spending far less time in the bathroom.
Steven
I think the nerves that manage my bladder and bowel have become really confused. Although I can control my bladder, if it is full, it gives me very short notice to get to a toilet.
But recently, I have noticed something strange. If I go to the toilet with a very full bladder, I also want to pass a stool. To make matters worse, the more I try to hold back the urine, the more active my bowel becomes.
Also, when I stress, my bowel goes into a knot and my farts become wet. So now, whenever I leave the house, I wear a sleeve catheter and a diaper. I carry spares in my backpack. I am starting to consider a colostomy.
From an old Rolling Inspiration article (paraphrased):
When I make love to my girlfriend and I reach climax, I pass a stool. For me it is a fact of life, my girlfriend must just get used to it.
In pursuit of happy crappies, non-bowel routine management options:
Trans-anal irrigation
This is a procedure where the person with a spinal cord injury or a carer inserts a catheter into the anus and inflates a balloon to keep the catheter in place, while seated on the toilet. Water is then pumped with a hand pump from a reservoir into the rectum (usually about 500 ml would suffice).
The increased volume in the rectum facilitates voiding of stool. The procedure appears to be safe and, apart from occasional reports of bowel perforation, side effects appear to be minimal provided that it is done with a recognised trans-anal irrigation product and following the supplier guidelines.
Advantages include fewer episodes of faecal incontinence, reduced time spent on bowel management and an overall improvement in the quality of life.
Colostomy
Until recently, colostomies were considered as a last resort procedure for failed bowel management in persons with a spinal cord injury. But, recent studies have found that the formation of a stoma can greatly improve the quality of life for some individuals. It can reduce the time spent on bowel management and it increases the independence (and ease) of bowel care.
However, despite largely positive outcomes, colostomies are not without complications. These include herniation of the stoma, skin rashes around the stoma (causing problems with collection bags), inflammation of the unused bowel below the stoma and a mucus discharge from the anus, that may require the use of pads or even surgical closure of the anus.
“[Colostomies] can greatly improve the quality of life for some individuals.”
However there is a very effective stoma support service from the suppliers of stoma products to assist and advise on stoma care and side effects.
A colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. During this procedure, one end of the colon is diverted through an incision in the abdominal wall to create a stoma.
A stoma is the opening in the skin where a pouch for collecting faeces is attached. People with colostomies have pouches attached to their sides where faeces collects and from which it can be easily disposed.
Antegrade continence enema (ACE)
This is a procedure where a small stoma is created at the origin of the large bowel. The stoma is then used to instil an enema or bowel irrigation behind the stool. Commonly used in children with spina bifida, its use in adults with spinal cord injuries has proved generally unsuccessful and is seldom seen in clinical practice.
Nerve stimulation techniques
This involves the surgical implantation of nerve stimulators that stimulate the nerves that cause voiding. Sacral Anterior Root Stimulators (SARS) have been in use for bladder management problems for some years and has been found in some individuals to promote simultaneous bowel evacuation.
This procedure, however, seems to be not popular as very few respondents to bowel management questionnaires report using this technique. Another procedure, Sacral Nerve Stimulation (SNS) has been found to be not effective in persons with a spinal cord injury although limited success has been reported in persons with cauda equina lesions.
The collection of nerves at the end of the spinal cord is known as the cauda equina, due to its resemblance to a horse’s tail. The spinal cord ends at the upper portion of the lumbar (lower back) spine.
If all else fails…
If nothing wants to work and you are moedeloos- gatvol-moerig, try wooing your bowel with the Happy Crappy song:
Come on baby, let’s do the happy crappy now
A snappy crappy is a happy crappy
So let’s do a snappy, happy crappy
Come on Baby, let’s have a snappy crappy
n-o-o-o-w.
Chorus:
Happy crappy, snappy crappy!
Happy snappy crappy, Yeah!
It is fairly certain not to work but maybe it will make you feel better…
References
Guidelines for Management of Neurogenic Bowel Dysfunction in Individuals with Central Neurological Conditions. Initiated by the Multidisciplinary Association of Spinal Cord Injured Professionals: https://www. mascip.co.uk/wp-content/uploads/2015/02/CV653N- Neurogenic-Guidelines-Sept-2012.pdf
Exploring the benefits of anal irrigation. Nursing Times: https://www.nursingtimes.net/clinical- archive/continence/exploring-the-benefits-of-anal- irrigation-27-04-2012/
Ida’s Corner is a regular column by George Louw, who qualified as a medical doctor, but, due to a progressing spastic paralysis, chose a career in health administration. The column is named after Ida Hlongwa, who worked as caregiver for Ari Seirlis for 20 years. Her charm, smile, commitment, quality care and sacrifice set the bar incredibly high for the caregiving fraternity. email: yorslo@icloud.com
