Neurogenic Bowel Program Overview - Reeve Foundation

Some individuals have issues with their bowel program. If this is not your circumstance, hooray. Individuals do have success with their bowel program, and you will as well. There are some tips that will help you improve your bowel success, or if you do not have issues with your bowel program, these may help make it even better.

An overview of high-level bowel program planning may have an influence on how your bowel program is working. If you are not having issues, consider some of the ideas for improvement or store them for future troubleshooting. If you have bowel concerns, this is a good opportunity for review. Sometimes, just the tiniest of changes can make a huge difference in output and time to complete the bowel program.

Bowel programs are developed for individuals with a neurogenic bowel diagnosis. This is an issue with the nerve communication between the brain and bowel for function. Neurogenic bowel is a particular diagnosis for which a specific treatment is prescribed. Not conforming to a neurogenic bowel program can lead to many extreme medical problems from upset stomach to overstretching the bowel, impaction of stool, hemorrhoids, fissures, and diverticulitis. It leads to embarrassment from uncontrolled bowel accidents and pressure injury from stool eroding the skin. In neurogenic bowel, evacuation may or may not occur based on how the nerves are affected. Control of bowel evacuation occurring, and at an appropriate time, is an issue.

Bowel programs are done in two ways. Individuals with reflexive neurogenic bowel include those who have tone or spasticity. What you see on the outside of the body, such as tone (spasticity), is usually the same inside the body where you cannot see. The spasticity or tone will affect the passage of stool through the bowel and the removal of the stool. In this case, a stimulant is placed into the rectum to cause the lower bowel to activate to bring the stool to the rectum. Digital stimulation is performed to relax and open the internal sphincter of the rectum for passage of the stool out of the body. Most bowel programs are performed every other day for those with reflexive neurogenic bowel from some brain injuries or higher-level spinal cord injuries.

For individuals with flaccid bowel or low to absent tone in the lower body, a bowel program consisting of manual removal of stool is necessary. The finger is inserted into the rectum to remove stool in the lower bowel. Daily bowel evacuation is done for flaccid neurogenic bowel from specific brain injuries or those with lower-level injuries.

One of the key issues in a bowel program is predictability. To accomplish this goal, set a time that you will complete your bowel program. The primary goal of a neurogenic bowel program is to train your bowel to work at a predictable time, not at random. This comes with establishing the time that you want to release stool, so it is under your control. Performing the bowel program at various times does not allow the bowel to receive cues for emptying, which does not allow predictability in evacuation, leading to accidents or impaction if the bowel program is not performed in a timely manner.

Most individuals do not realize the importance of maintaining a specific time for the neurogenic bowel program. The bowel can be trained to evacuate with the cues that you provide for emptying. The cues are the cathartic stimulant of a suppository or mini enema and digital stimulation to open the internal sphincter for those with reflexive neurogenic bowel and manual removal for flaccid bowel.

It may seem strange that predictability is possible when you are accustomed to self-body control as pre-injury, but this timing is critical in neurogenic bowel programs. The bowel is a habit-forming organ. If you think about it, most people have bowel habits when they empty their bowel routinely prior to injury. It might be after their coffee in the AM, coffee being a bowel stimulant. Or it may be after a large meal, such as dinner. There are a variety of bowel habits that individuals have, pre-neurogenic bowel that they really did not think much about but is there.

Inpatient time in a rehabilitation hospital can be limited. Regulation of the neurogenic bowel to a predictable bowel program takes time. Regulating the bowel for complete evacuation on your established bowel program time is a process. Some can regulate their bowel in three to four weeks. For others, it may take as much as six months. Most are somewhere in between those times. Often, individuals think they have their neurogenic bowel program regulated only to have an accident seemingly out of the blue.

Gravity is the best friend of the neurogenic bowel program. Pre-neurogenic injury, you evacuated your bowel on the toilet, sitting up. In some countries, the bowel is evacuated in the squatting position, which is even better for engaging the abdominal muscles. But sitting up is effective in helping to expel and drop stool out of your body.

You may have been taught to perform a bowel program in bed. Transitioning to an upright position on the toilet or commode helps facilitate the use of gravity to expel stool. If you have not learned this method in the rehabilitation setting, speak to your healthcare professional about transitioning to sitting up at home.

You may be eligible for home health providers or outpatient therapy to teach you how to accomplish this goal. There are also videos online to see demonstrations so you will see how it works. You will need a commode chair with secure breaks or locks that can be placed over the toilet. If you have sitting balance, you can transfer directly to the toilet. Consider your needs for pressure dispersing cushioning as well. Sitting upright facilitates the use of gravity, as well as making clean-up much easier for you or your caregiver.

Subtle events can affect the regulation of your neurogenic bowel program. You might eat food that does not agree with you, illnesses that affect your bowel, or even stress that can speed your bowel unfavorably. Even prior to the diagnosis of neurogenic bowel, people have bowel events such as diarrhea or constipation (hard stool). Try to recall times that events or food affected your bowel, as these same occurrences can happen after neurogenic bowel, but now without the warning of impending concern.

Even the change in diet from rehabilitation hospital food to home cooking can affect your neurogenic bowel, which will require time for re-regulation and adjustment. Perhaps you enjoyed spicey foods prior to the development of a neurogenic bowel, but you have been hospitalized for some time without being able to enjoy your regular diet. Reintroducing those spicey dishes can lead to bowel accidents. You can return to your previous diet but do so slowly. Bowel surprises happen but can be controlled with an effective neurogenic bowel program.

Adjusting to the idea of a neurogenic bowel program does take some effort for most individuals. Neurogenic bowel is a diagnosis not many have heard about. It certainly is not a diagnosis on a TV medical show, which is where most individuals get their medical information! So, the idea of placing your finger in your rear is a shock. Getting over that phobia can be a challenge. Hopefully, your rehabilitation care team has been professional and caring to help ease you into the process. This is your new normal, and it should be considered in that way.

The good news is that the neurogenic bowel program can be mastered. It does take time to perform the program as well as to regulate the bowel. Success is possible. Next week, a detailed review of technique tips will be listed for your consideration.

Pediatric Consideration:
Neurogenic bowel can affect anyone of any age. Neurogenic bowel programs should be started as soon as a neurogenic bowel diagnosis is determined regardless of age. Children need to have their bowel program individualized for them using smaller doses of the cathartic agent and perhaps the caregiver’s pinky finger for digital stimulation or manual removal.

Some believe bowel overflow caught by a diaper is acceptable, as babies wear diapers. But with neurogenic bowel, the bulk of the stool remains. Stretching the elastic bowel without contracting can lead to further issues as the child grows or when they become adults. If a neurogenic bowel is diagnosed, a bowel program is needed.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.
Find out about Nurse Linda here.