Last week started a review of the bowel program process with presentation of the usual routine.
This week, a closer look at some of the complications that can hamper the bowel program is reviewed.
Autonomic Dysreflexia
Problems with your bowels or bowel program may lead to episodes of Autonomic Dysreflexia (AD). The number one source of AD is usually something amiss with the bladder, but the number two source is the bowel (no pun intended). AD can develop from an overfilled bowel, diarrhea, gas, impaction or even due to the stimulation of the bowel program itself.
The most common signs of AD are a pounding headache and elevated blood pressure from your individual normal. There are other signs as well. Sometimes silent AD can be occurring which is an elevated blood pressure with no other symptoms. Be well aware of all of the signs of AD by checking the wallet card. AD is a serious medical emergency that requires attention. If you have multiple episodes of AD with your bowel program, medication can be prescribed to control it.
Changing your bowel program
Consistency in timing is the rule for training your bowel to work effectively. However, sometimes life changes and you need a new schedule. This cannot occur very often as you really need steady timing for your bowel program to work. However, on that rare occasion, you can change your bowel schedule.
Start your bowel program at your newly selected time. Stop, your usual program. Perform the bowel program at the new time daily until stool is evacuated at the new time for 2-3 days with no incontinence in between. You may not have results daily. Then you can move to every other day at the new time. It can take weeks or sometimes even months to regulate your bowel to the new schedule. Accidents in between can be frustrating so be prepared for that consequence. Some individuals will sail through the process but by far the majority will find changing bowel program times to be a challenge at best.
Gravity
Gravity is often overlooked as one of the biggest helpers in bowel movements. You might have been taught just to do the bowel program in bed. However, sitting upright will help stool pass from your body.
To accommodate sitting, you are eligible for a commode chair or even a shower chair which can be dually used for your bowel program. Have your therapist, nurse or healthcare professional assist you with ordering your commode to ensure you have all the adaptions needed specifically for you such as appropriate breaks, removable and elevating foot rests, removable arm rests, head rest, reclining, appropriate padding for skin care and safety belts. Be sure the size of the commode can be accommodated in your home. Check with your insurance case manager to learn about the payment system.
If you have a medical reason that you cannot sit up for the bowel program, position yourself on your left side. The bowel program will work better in bed if you are on your left side due to the anatomical placement of the bowel within the body.
Movement
One of the factors for everyone that helps the bowel move is use of your muscles, especially the abdominal muscles. Movement helps everyone’s bowels to work more efficiently and functionally. People who live sedentary lifestyles even without spinal cord injury have more difficulty with bowel movement than those who move their bodies.
There are some simple activities that will insert movement into your life. Roll from side to side when in bed, do wheelchair pushups for pressure release, do range of motion exercises especially to the legs and hips, exercise especially the lower body or have someone do these activities to your body. Since the bowels are inside the body, we don’t see them moving but muscle action helps propel stool through the bowel. Therefore, supply what is needed to enhance the process.
Gas
Bloating and gas can be an issue for individuals with neurogenic bowel. The slowing of the bowel can lead to a buildup of gas in the bowel which appears as bloating. Movement can help resolve some of the issue because it pushes gas along in the bowel. Eating foods that produces little gas can help.
Gas reducing tablet medication is also available. Take gas reduction medication when needed, not as a routine, if possible. Be cautious with your reduction of gas reduction technique. Gas in the bowel is one of the ways chyme is propelled through the bowel. It is a necessary action. Eliminating gas can block the bowel function process.
Sensation with a bowel program
Individuals with incomplete injuries or with partial preservation of some nerves may have some sensation with the bowel program. The messages may be transmitted that something is going on in the bowel or the messages can be mis-transmitted as pain. The simplest treatment is to use a rectal topical anesthetic at the time of the bowel program. This analgesia can be inserted prior to the initiation of the bowel program or it can be used as lubricant, depending on your specific needs. If there is no success with this treatment, neuropathic pain medication or spasticity medication may be necessary.